(CS-049) Slow Release Iodine Dressings in Large Burns: Outcomes & Thyroid Function

Iodine containing dressings comprise various contraindications for patients with thyroid disfunction (e.g., Graves’, Hashimoto’s, and Goiter). Further, precautions for surface areas greater than labeled limits for single and cumulative applications are provided. However, immediate release/high dose iodine products (povidone/tincture) are the basis for most of these precautions. Limited data exists for slower releasing/lower dose iodophors.

 


High TBSA burns are known metabolic crises resulting in hypermetabolic states. The acute thyroidal response is reported as a predictable drop in thyroid hormone marked by inconsistent TSH levels over time. Patient criticality, pharmacotherapy (corticosteroids/vasopressors), and thyroid function are all identified as potential sources of variability.

Methods:

A retrospective case series was reviewed with large TBSA burn patients treated in our center with a new, lower dose, slow release iodophor foam dressing^Ṫ. The patient histories of patients were reviewed for clinical outcomes and thyroid function in comparison with cases in the literature.

^ṪIoPlex® Iodophor Foam Dressing

Results: The cases that follow demonstrate successful clinical outcomes for the dressing’s primary objective. The associated tabular summary of longitudinal data indicate that no thyroid function tests was conclusively altered, even at the high TBSA treated, due to any apparent iodine exposure. Three of the eight patients reviewed, did have TSH levels above normal; however, these values were prior to iodine exposure or variable during exposure and not outside of the published TSH values for similar sized wounds untreated with I. In contrast, five of the eight patients treated showed no impact to TSH levels at all, even at the high TBSA treated, including a patient with documented Hashimoto’s disease and one patient with a partial thyroidectomy.

Discussion: This retrospective analysis provides new data and many questions. While no clear iodine-thyroid impact was identified, a thyroid-severe burn link is validated. Hence, regular TFT’s appear to be warranted in severe burns. Interestingly, a true mapping of the longitudinal thyroid response appears lacking in the literature. Based on days post injury alone, TFT’s can appear high or low. A more comprehensive analysis might include regular TF testing as well as serum iodine levels longitudinally.