Bjekic-Macut J, Baltic T, Petrovic Nikolic T, Brankovic M, Brajkovic M, Nikolic N, Ivanovic N, Zdravkovic M
Klinicko Bolnicki Centar Bezanijska kosa - Department of Endocrinology, Serbia.
University of Belgrade, Faculty of Medicine - Internal Medicine, Beograd, Serbia.
Acta Endocrinol (Buchar). 2024 Jul-Sep;20(3):384-387. doi: 10.4183/aeb.2024.384. Epub 2025 May 23.
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.
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.
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.
甲状腺危象是一种发生于严重甲状腺毒症的极端病症。这种情况危及生命，死亡率高达10%-20%。一剂典型的碘化造影剂（ICM）含有约13500μg游离碘和15-60g结合碘，相当于每日推荐摄入量150μg的90至数十万倍的急性碘负荷。由于突然暴露于高碘负荷下，甲状腺激素调节可能会受到干扰，导致甲状腺功能减退（沃尔夫-柴可夫效应）或甲状腺功能亢进（约德-巴塞多现象），尤其是在患有潜在结节性甲状腺疾病的患者中。
一名37岁男性因急性心肌梗死的临床和心电图表现就诊于急诊室（ER）。进行了使用碘化造影剂的直接经皮冠状动脉介入治疗（PCI）。干预后，实验室分析显示甲状腺毒症，患者接受了初始甲状腺抑制治疗以及心脏治疗后出院。一周后，他因甲状腺危象的症状再次入院。
本病例报告旨在提高对急性心肌梗死和冠状动脉造影患者甲状腺功能常规评估的认识，无论患者此前有无甲状腺毒症的体征和症状。
