Hyperthyroidism-associated coronary spasm: A case of non-ST segment elevation myocardial infarction with thyrotoxicosis

Abstract

Hyperthyroidism is associated with many heart diseases. Thyrotoxic state has a relationship with coronary spasm. We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain. The diagnosis of coronary spasm was confirmed by coronary angiography (CAG). She is treated well with anti-thyrotoxicosis and anti-anginal medication. We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.

Hyperthyroidism presenting as ST Elevation Myocardial Infarction - A Case Report

“… 6 Higher levels of prothrombotic factors and lower levels of anticoagulative factors have been demonstrated among patients with a history of thyroid cancer receiving TSH-suppressive L-thyroxine therapy in comparison the same subjects in hypothyroid phase prior to radioiodine whole-body scanning procedure. 6 Homoncik et al, reported raised concentrations of von-Willibrand factor (vWF) and increased baseline platelet plug formation in patients with thyrotoxicosis which were corrected by treatment of thyrotoxicosis with thionamides. 7 Vasospastic angina secondary to transient coronary vasospasm occurs in up to 20% of hyperthyroid patients, yet is difficult to confirm.…”

Thyrotoxicosis Mimicking ST Elevation Myocardial Infarction

“…Coronary events occur 2.6 times more frequently in the presence of high free triiodothyronine levels as compared to normal levels [ 4 ]. Reported cardiac events in this setting include myocardial ischemia, angina, arrhythmia, congestive heart failure and sudden death [ 1 , 5 ]. Proposed hypotheses consist of significant underlying atherosclerosis of the coronaries, overactive sympathetic system, coronary embolization, direct damage to the coronaries and disruption of the blood supply to oxygen demand [ 1 , 6 ].…”

“…However, previous reports do not support the use of coronary angiography as a first diagnostic test in patients presenting with chest pain with underlying uncontrolled hyperthyroidism because iodine containing agents (e.g. those used in coronary angiography) have the potential to induce thyrotoxicosis [ 1 , 5 ]. Thyrotoxicosis induced vasospasm can occur at any time of day which differentiates it from variant angina-related vasospasm that typically occurs in the morning [ 6 ].…”

“…Thyrotoxicosis induced vasospasm can occur at any time of day which differentiates it from variant angina-related vasospasm that typically occurs in the morning [ 6 ]. Possible mechanisms of thyrotoxicosis-induced vasospasm include enhanced coronary sensitivity to vasoconstrictors and reduced sensitivity to vasodilators [ 1 ]. Furthermore, coronary vasospasm can promote atherosclerosis by accelerating the formation of a thrombus and delaying fibrinolysis [ 1 ].…”

“…Hyperthyroidism is well known to be associated with heart disease [ 1 ]. Although this association was reported in the medical literature since the 20th century, there are frequent delays in making the diagnosis [ 2 ].…”