KMID : 1202020130060010064
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Journal of Korean Thyroid Association 2013 Volume.6 No. 1 p.64 ~ p.68
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Clinical Characteristics of Thyrotoxicosis Presented by Coronary Spasm
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Kim Ki-Won
Lee Sae-Hwan Chun Sung-Wan Kim Yeo-Joo Kim Sang-Jin
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Abstract
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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£ºfemale, 5£º7). 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.
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KEYWORD
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Thyrotoxicosis, Coronary vasospasm
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