July - September 2024, Volume 20, Issue 3

Bjekic-Macut J, Baltic T, Petrovic Nikolic T, Brankovic M, Brajkovic M, Nikolic N, Ivanovic N, Zdravkovic M

Iodinated Contrast Media Induced Thyroid Storm and Acute Coronary Syndrome: A Case Report

Acta Endo (Buc) 2024, 20 (3): 384-387
doi: 10.4183/aeb.2024.384

Background. A thyroid storm is an extreme disorder that occurs in severe thyrotoxicosis. This condition is life-threatening, with mortality rates up to 10-20%. A typical dose of iodinated contrast media (ICM) contains approximately 13,500 μg of free iodide and 15–60 g of bound iodine, representing an acute iodide load of 90 to several hundred thousand times the recommended daily intake of 150 μg. As a result of sudden exposure to high iodide loads, thyroid hormone regulation can be disrupted, leading to hypothyroidism (Wolff-Chaikoff effect) or hyperthyroidism (Jod-Basedow phenomenon), particularly in those with underlying nodular thyroid disease. Case description. A 37-year-old man presented to the emergency room (ER) with clinical and electrocardiographic signs of acute myocardial infarction. Primary PCI with iodinated contrast was performed. After the intervention, laboratory analyses revealed thyrotoxicosis, and the patient was administered initial thyrosuppressive therapy along with cardiac therapy and discharged from the hospital. One week later, he returned to the hospital with signs of a thyroid storm. Conclusion. This case report aimed to raise awareness regarding the routine evaluation of thyroid function in patients with and without previous signs and symptoms of thyrotoxicosis who had undergone acute myocardial infarction and coronary angiography.

Keywords: iodinated contrast, PCI, acute myocardial infarction, PTU, thyroid storm.

Correspondence: Tamara Baltic MD, KBC Bežanijska kosa, Endocrinology, Zorza Matea bb, Beograd, 11080, Serbia, E-mail: tamaravukasin@gmail.com