2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Research Snapshot Theater: Endocrine, Adult II

A Case of Iodinated Contrast-Induced Thyroid Storm and Respiratory Arrest

Monday, March 23, 2026
9:00 AM - 10:00 AM Central Time
Location: Connections Central - RST 01

  • Madiha Fathima, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SR

    Syed Fazal Rizvi, MD

    Resident Physician
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

  • MS

    Muhammad Asif Saleem, MD

    Resident Physician
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

  • WA

    Wajeeha Akhter, MD

    Endocrine Fellow
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

  • JD

    Jonathan R. Daniels, MD

    Program Director
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

  • JG

    Janice L. Gilden, MD, MS

    Chief of Endocrinology
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

  • AN

    Amin Ur Rehman Nadeem, MD, FCCP

    Attending physician in Critical Care
    Chicago Medical School/Rosalind Franklin University

    Disclosure information not submitted.

Introduction: Thyroid storm (TS) is a rare, life-threatening complication of hyperthyroidism. It is precipitated by acute stressors like iodinated contrast exposure, trauma, surgery, or infection. With rising use of contrast imaging, clinicians must stay vigilant in at-risk patients. We present a case of iodinated contrast-induced TS resulting in respiratory arrest in a 78-year-old male with a known history of Graves’ disease.


Description: A 78-year-old male with past medical history of hyperthyroidism, COPD, and CAD was brought to the emergency department (ED) by EMS due to altered mental status, shortness of breath, chest discomfort, tremors, and generalized weakness. In the ED, he was found to be tachycardic and hypertensive. Labs indicated hypercalcemia with normal troponin. Computed tomography angiography (CTA) was negative for pulmonary embolism but demonstrated goitrous enlargement of thyroid gland. Shortly after imaging, patient rapidly deteriorated, presenting with agitated delirium, severe tachycardia, hypertensive crisis, and respiratory arrest requiring ICU care. His agitated delirium persisted despite maximum recommended dose of dexmedetomidine and repeated doses of haloperidol, ultimately resolving only after intubation and administration of IV propofol. History revealed noncompliance with methimazole and a previous history of TS. Endocrinology was consulted. Thyroid function test was remarkable of TSH < 0.010 (ref 0.35–5.0), Free T4 5.03 (ref 0.7–1.25), Free T3 15.03 (ref 1.7–3.7), anti-thyroglobulin level of 32 (ref < 116), thyroperoxidase antibodies 156 (ref < 51). His Burch Wartofsky score was 55, consistent with iodinated contrast-induced thyroid storm. He was treated with IV hydrocortisone, propranolol, and propylthiouracil, with subsequent clinical improvement.


Discussion: Older adults with hyperthyroidism often present to the ED and the growing reliance on iodinated contrast raises concerns for contrast-induced thyrotoxicosis. In individuals with thyroid disease, iodide exposure can trigger clinically significant thyrotoxicosis. Therefore, it is crucial to assess risk factors such as history of thyroid disease/thyroid storm and remain vigilant for signs of thyrotoxicosis following contrast administration, particularly when a patient exhibits an atypical clinical course.