Journal List > J Korean Thyroid Assoc > v.6(1) > 1056543

Kiwon, Se, Sung, Yeo, and Sang: Clinical Characteristics of Thyrotoxicosis Presented by Coronary Spasm

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.

References

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Table 1.
Clinical profiles of patients with coronary artery spasm associated with thyrotoxicosis
No. Sex/Age Clinical presentation Angiographic finding TFT Diagnosis Thyrotoxic symptoms
1 F/27 Exertional chest pain Pan–arterial, diffuse vasoconstriction T3: 4.83 ng/mL
fT4: >7.77 ng/dL
TSH : 0.006 uIU/mL
Painless thyroiditis None
2 M/58 Resting chest pain p–mRCA spasm T3: 4.11 ng/mL
fT4: 6.38 ng/dL
TSH: 0.005 uIU/mL
Graves’ disease None
3 M/55 Exertional chest pain I.C. ergonovine: RCA, diffuse vasoconstriction T3: 2.87 ng/mL
fT4: 4.4 ng/dL
TSH: 0.005 uIU/mL
Graves’ disease Sweating, palpitation, fatigue, weight loss
4 M/38 Resting chest pain I.C. ergonovine: total occlusion of mid-RCA T3: 2.28 ng/mL
fT4: 3.09 ng/dL
TSH: 0.005 uIU/mL
Painless thyroiditis None
5 M/62 Exertional chest pain LCA, diffuse intense vasoconstriction T3: 3.23 ng/mL
fT4: 6.75 ng/dL
TSH: 0.01 uIU/mL
Graves’ disease Palpitation, weight loss
6 F/50 Resting chest pain I.C. ergonovine: RCA, diffuse vasoconstriction T3: 3.82 ng/mL
fT4: 5.90 ng/dL
TSH: 0.005 uIU/mL
Graves’ disease Fatigue, palpitation
7 F/52 Resting chest pain I.C. ergonovine: RCA, diffuse vasoconstriction T3: 3.39 ng/mL
fT4: 2.21 ng/dL
Graves’ disease None
8 F/52 Resting chest pain Pan-arterial, diffuse vasoconstriction TSH: 0.005 uIU/mL
T3: 7.18 ng/mL
fT4: 5.88 ng/dL
Graves’ disease None
9 F/63 Exertional chest pain Spasm of LCA TSH: 0.005 uIU/mL
T3: 4.02 ng/mL
fT4: 3.63 ng/dL
Graves’ disease None
10 F/59 Resting chest pain Osteal left main spasm TSH: 0.05 uIU/mL
T3: 3.47 ng/mL
fT4: 2.94 ng/dL
TSH: 0.021 uIU/mL
Painless thyroiditis None
11 F/56 Resting chest pain Mid-RCA spasm T3: 2.03 ng/mL
fT4: 2.02 ng/dL
TSH: 0.005 uIU/mL
Graves’ disease None
12 M/68 Resting chest pain syncope Total occlusion of LCX due to vasospasm and spasm of LAD, RCA T3: 3.85 ng/mL
fT4: 6.86 ng/dL
TSH: 0.005 uIU/mL
Graves’ disease Fatigue, sweating, tremor, weight loss

F: female, I.C. : intracoronary, LAD: left anterior descending, LCA: left coronary artery, LCX: left circumflex artery, M: male, p-mRCA: proximal-mid right coronary artery, RCA: right coronary artery, TFT: thyroid function test

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).
jkta-6-64f1.tif
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