Objective:

To report a case of hyperthyroidism-associated spontaneous coronary artery dissection (SCAD) and explore the link between severe thyrotoxicosis and coronary arterial vulnerability.

Approach:

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Key Findings:

• Emergent coronary angiography revealed a long narrowing in the left anterior descending artery with preserved TIMI 3 flow, indicating a non-obstructive lesion consistent with MINOCA.
• Intravascular ultrasound at three months confirmed persistent intramural hematoma, diagnosing SCAD.
• The patient remained asymptomatic at one-year follow-up.

Interpretation:

This case presents a potential association between severe thyrotoxicosis and coronary arterial vulnerability, highlighting the diagnostic challenges in MINOCA presentations.

Limitations:

• The case is a single report and may not be generalizable.
• The staged approach may not be applicable in all cases of MINOCA.

Conclusion:

Severe thyrotoxicosis may contribute to SCAD, and a staged diagnostic strategy can minimize procedural risks in such patients.