J Korean Thyroid Assoc.  2013 May;6(1):64-68. 10.11106/jkta.2013.6.1.64.

Clinical Characteristics of Thyrotoxicosis Presented by Coronary Spasm

• Kim K
• Lee SW
• Chun SW
• Kim YJ
• Kim SJ

• KMID: 1428455
• DOI: http://doi.org/10.11106/jkta.2013.6.1.64

Abstract

BACKGROUND AND OBJECTIVES
Cardiovascular symptoms are integral and often the most predominant clinical presentation in patients with thyrotoxicosis. In patients with known or suspected coronary artery disease, myocardial ischemia and angina-like chest pain may be presented due to increase in cardiac output and cardiac contractility as a result of thyrotoxicosis. In addition, coronary spasm may result in angina-like chest pain in thyrotoxicosis patients without any fixed coronary artery stenosis. However, there are few reports about clinical characteristics of thyrotoxicosis associated with coronary artery spasm.
MATERIALS AND METHODS
Coronary angiography, thyroid function test, and follow-up clinical data of patients were analyzed retrospectively.
RESULTS
Twelve patients with coronary artery spasm were included over 4.5 years (male:female, 5:7). The mean age of patients was 53.3 years (range, 27 to 68), and female patients were younger than male patients (mean, 56.2 vs. 51.2 years). Only 4 patients (33%) presented typical thyrotoxic symptoms. The causes of thyrotoxicosis were Grave's disease (75%) and painless thyroiditis (25%). On coronary angiography, severe coronary spasm was observed by provocation in 6 patients, and total occlusion of right coronary artery and left circumflex artery with chest pain developed in 2 of 6 patients. After antithyroid treatment, all patients became free of chest pain.
CONCLUSION
Severe coronary artery spasm can be associated with thyrotoxicosis. Thyroid function test might be a differential diagnostic test in patients with coronary artery spasm. It should be considered that thyrotoxicosis can be presented by coronary artery spasm without typical symptom of thyrotoxicosis.

Keyword

Thyrotoxicosis; Coronary vasospasm

MeSH Terms

Arteries
Cardiac Output
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vasospasm
Coronary Vessels
Diagnostic Tests, Routine
Female
Follow-Up Studies
Humans
Male
Myocardial Ischemia
Spasm
Thorax
Thyroid Function Tests
Thyroid Gland
Thyroiditis
Thyrotoxicosis

Figure

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  Fig. 1. Angiograms showing the diffuse severe spasm that involved the left coronary artery (A). After an intracoronary nitroglycerin injection, the coronary arteries became fully dilated and they appeared normal (B).

Reference

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