1. CREST Seminar Presentation March 10, 2015 Sun Y. Lee, MD 2 nd year Crest Fellow

2. Overview

4. Epidemiology Smith-Bindman, R. et al. JAMA 2012;307(22):2400-2409

5. Why are We Interested in the Urinary Iodine Clearance after ICM Administration?

6. Overview

7. Urinary Iodine Excretion after ICM Exposure in Patients s/p Total Thyroidectomy Padovani, R. et al. Thyroid. 2012;22(9):926-930

8. Urinary Iodine Excretion after ICM Exposure in Patients s/p Total Thyroidectomy Comparison of urinary iodine concentration according to time interval between CT scan and urine iodine measurements. Sohn, et al. Thyroid 2014; 24(5): 872-877.

9. Urinary Iodine Excretion after ICM Exposure in Patients without Thyroid Disease Nimmons, GL. et al. JAMA Otolaryngol Head Neck Surg. 2013;139(5):479-482

10. Comparison of Urinary Iodine Clearance between Athyreotic Patients and Patients with Intact Thyroid Glands Ho, et al. Journal of Thyroid Research, 2014;article ID 580569

11. Overview

12. Study Objectives

13. Study Subjects

14. Methods Week 0 – at CT Wk 1-4 - Weekly Wk 6-24 - Biweekly Only if UIC not back to baseline at Week 4  Measurements Spot UIC and TFTs at every visit Thyroid ultrasound within the first 4 weeks of follow-up. BaselineFollow-upExtended Follow-up

15. Outcomes of Interest

16. Statistical Analyses

18. Overview

19. Baseline Characteristics of Subjects Mean±SD or Median (Range) Age (years)50.8±12.4 Amount of iodine administered (grams) 34.5±6.1 UIC at baseline (µg/L)105.6 (10.0-866.1) TSH at baseline (mIU/L)*1.26 (0.5-11.2) FT4 at baseline (ng/dL)*0.83 (0.47-1.34) TT3 at baseline (ng/mL)*1.40 (0.71-2.34) n=54, except *n=51

20. Descriptive statistics

21. Median Urinary Iodine Concentrations following ICM Administration

22. Development of Incident Thyroid Dysfunction after ICM Administration

23. Univariate Correlations between Covariates and Duration to Normalization of UIC after ICM Administration CovariatesCorrelation CoefficientP-value Age (years)0.0240.87 Amount of iodine received (grams) -0.2070.137 Thyroid volume (cm 3 )0.0170.90 Baseline UIC (mcg/L)-0.2190.116 Peak UIC (mcg/L)-0.0470.74 Duration to peak UIC (weeks) 0.0260.86 Baseline TSH (µIU/L)*0.0750.61

24. Univariate Correlations between Covariates

25. Univariate Correlations between Covariates and Development of Incident Thyroid Dysfunction after ICM Administration CovariatesCorrelation CoefficientP-value Age (years)0.0470.75 Amount of iodine received (grams) 0.0960.51 Thyroid volume (cm 3 )-0.0910.53 Baseline UIC (mcg/L)-0.1430.33 Peak UIC (mcg/L)-0.0560.70 Duration to peak UIC (weeks) -0.0560.70 Duration to normalization of UIC (weeks) 0.0760.60 Baseline TSH (µIU/L)0.1940.18

26. Multivariate Linear Regression Model Predicting Peak UIC after ICM Administration PredictorsBeta-coefficientp-value Age (years)695.450.024* Amount of iodine received (grams)2866.31<0.001* Thyroid volume (cm 3 )-215.290.77 Presence of nodules ≥ 1cm2899.080.67 Gender N/A 0.34 Race/ethnicityN/A0.77 Smoking statusN/A0.98 Place of birthN/A0.76 History of autoimmune diseaseN/A0.40 Family history of thyroid diseaseN/A0.47 Family history of autoimmune diseaseN/A0.05 Baseline UIC (mcg/L)-3.970.83 Baseline TSH (mIU/L)-471.900.76 Baseline FT4 (ng/dL)-2890.390.90 Baseline TT3 (ng/mL)-2877.180.57 Overall model p-value = 0.035

27. Multivariate Regression Models

28. Overview

29. Conclusion

30. Acknowledgement

31. Questions?

32. Baseline Serum Thyroid Function Abnormalities

33. Summary of Findings

34. Strength of Our Study

35. Limitations of Our Study