Clinical Report: Hyperthyroidism-Related Spontaneous Coronary Artery Dissection

Overview

This case study presents a 56-year-old female with uncontrolled Graves’ disease who experienced a ST-segment elevation myocardial infarction (STEMI) due to spontaneous coronary artery dissection (SCAD). The diagnosis of SCAD was confirmed through deferred intravascular imaging.

Background

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of myocardial infarction with non-obstructive coronary arteries (MINOCA). The association between Graves’ disease and coronary arterial injury is not fully understood.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• A 56-year-old female with uncontrolled Graves’ disease presented with STEMI.
• Coronary angiography revealed a long narrowing in the left anterior descending artery with preserved TIMI 3 flow.
• The lesion did not respond to intracoronary nitroglycerin, supporting a diagnosis of MINOCA.
• Intravascular ultrasound at three months confirmed a persistent intramural hematoma, indicating SCAD.
• The patient remained asymptomatic at one-year follow-up.
• A staged diagnostic approach was utilized to minimize the risk of thyroid storm during evaluation.

Clinical Implications

This case highlights the importance of recognizing SCAD in patients with uncontrolled hyperthyroidism.

Conclusion

This case highlights the complexities of diagnosing MINOCA in patients with hyperthyroidism.

Related Resources & Content

1. Clinical Research in Cardiology, 2023 -- Coronary Microvascular Dysfunction Characterizes All Variants of MINOCA
2. The Journal of Clinical Endocrinology & Metabolism, 2023 -- Management Strategies for Patients Experiencing Thyroid Storm
3. European Journal of Preventive Cardiology, 2023 -- Familial risk of myocardial infarction with non-obstructive and obstructive coronary arteries: a nation-wide cohort study
4. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
5. Spontaneous coronary artery dissection: dissecting an underdiagnosed problem | Netherlands Heart Journal
6. Frontiers | Case Report: Spontaneous coronary artery dissection presenting as MINOCA in uncontrolled Graves’ disease
7. Frontiers in Pediatrics — Case Report: Graves' disease in a toddler with maple syrup urine disease: therapeutic challenges and surgical resolution
8. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
9. Spontaneous coronary artery dissection: dissecting an underdiagnosed problem | Netherlands Heart Journal | Springer Nature Link
10. Frontiers | Case Report: Spontaneous coronary artery dissection presenting as MINOCA in uncontrolled Graves’ disease