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● Formally, prophylaxis is unnecessary in patients with negative history of thyroid disease, no thyroid gland enlargement, and no clinical symptoms of hyperthyroidism. However, in regions of endemic goiter such as Germany, latent hyperthyroidism (TSH<0.5 mIU/L) due to thyroid autonomy is found in 7% of patients scheduled for iodine contrast media administration. The additional determination of TSH  is therefore particularly sensible in all patients in such regions, most importantly in older ones with cardiac disease.
● Patients with latent hyperthyroidism (6% in South Germany) should be given sodium perchlorate 2 hours prior and 7-10 days after the procedure. Beta blockers should be considered in patients with cardiac disease.
● Patients with manifest hyperthyroidism (1% in South Germany) should be given iodine contrast media only if absolutely necessary (life-saving emergencies, no alternative diagnostic procedures) in consultation with an endocrinologist. If possible, sodium perchlorate should be started 2 days prior to the procedure and it should be supplemented with a beta blocker and with methimazole. ≣ Chapter 1.3.1