Endocrine Abstracts

Background: Thyroid storm is an extreme disorder that occurs in case of severe thyrotoxicosis. This is a life-threatening condition 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 to 60 g of bound iodine, which represents 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 years old man, presented to the emergency room (ER) with clinical and ECG signs of acute myocardial infarction (AMI). Primary percutaneous coronary intervention with the administration of ICM has been performed. After the intervention, laboratory analyses reviled thyrotoxicosis, and he was given initial thyrosuppressive therapy with cardiac therapy and was discharged from the hospital. One week later, he returned to the hospital with the signs of thyroid storm. His thyroid hormones were high (FT4 260 pmol/l, undetectable TSH) and he scored 45 points on Burch-Wartofsky Point Scale. His therapy was changed into propylthiouracil 4 × 300 mg, Dexamethasone 2 × 4 mg, and Lugol’s solution. His condition was further complicated with a spread of skin lesions that looked like vasculitis. Since there has been a great concern that this was propylthiouracil induced vasculitis the drug was replaced with thiamazole. It has been decided that the definitive therapy for the patent condition is surgical ablation. After prolonged hospitalization successful total thyroidectomy was performed after FT4 fall below 30 pmol/l. Pathophysiology examination of thyroid gland reviled colloid nodal goiter, which was not in correlation with the echosonography findings.

Conclusion: We presented an unusual case of thyroid storm in a patient that developed AMI and without a history of thyroid disease prior to cardiac angiography with ICM used. We aimed to raise attention on the routine evaluation of thyroid function in patients with and without previous signs and symptoms of thyrotoxicity and who had an AMI, that undergone coronary angiography. Moreover, this could be an asset as progressively more people with coronary disease will undertake this procedure. If increased thyroid hormones are detected, a patient should be carefully monitored in intensive care units.

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