Rymer De Marchena Ingrid, Gutman Anna, Zaidan Julie, Yacoub Harout, Hoyek Wissam
Internal Medicine, Staten Island University Hospital, Northwell Health.
Cardiology, Staten Island University Hospital, Northwell Health.
Cureus. 2017 Jun 7;9(6):e1323. doi: 10.7759/cureus.1323.
Hyperthyroidism is well known to be associated with cardiac disease. Delay in making the diagnosis and occurrence of complications are common and are associated with a worse outcome. A 54-year-old male, non-smoker, with no past medical history and no significant family history presented to our hospital with severe left sided chest pain, "crushing" in nature. Electrocardiogram showed ST-segment elevations in the inferior leads. Troponin I level was 0.32 ng/mL (normal range 0-0.05 ng/mL) on presentation. The patient underwent an emergent coronary angiography which showed no evidence of occlusive coronary artery disease. The patient's symptoms and signs prompted a high suspicion of thyrotoxicosis which was subsequently confirmed by a low thyroid stimulating hormone and high free thyroxine levels. The patient was given Methimazole and atenolol and his symptoms resolved. Awareness of coronary vasospasm due to thyrotoxicosis should be raised in patients presenting with typical angina pectoris with subsequent normal coronary angiographic results. History and physical examination may suggest underlying hyperthyroidism, but the absence of typical findings does not rule out the diagnosis.
众所周知，甲状腺功能亢进与心脏疾病有关。诊断延迟和并发症的发生很常见，且与较差的预后相关。一名54岁男性，不吸烟，无既往病史及明显家族史，因严重的左侧胸痛（性质为“压榨性”）前来我院就诊。心电图显示下壁导联ST段抬高。就诊时肌钙蛋白I水平为0.32 ng/mL（正常范围0 - 0.05 ng/mL）。患者接受了紧急冠状动脉造影，结果显示无阻塞性冠状动脉疾病证据。患者的症状和体征高度怀疑甲状腺毒症，随后通过低促甲状腺激素水平和高游离甲状腺素水平得到证实。患者接受了甲巯咪唑和阿替洛尔治疗，症状得以缓解。对于出现典型心绞痛且冠状动脉造影结果正常的患者，应提高对甲状腺毒症所致冠状动脉痉挛的认识。病史和体格检查可能提示潜在的甲状腺功能亢进，但缺乏典型表现并不能排除诊断。
