甲状腺功能亢进伴冠状动脉痉挛1例

Hyperthyroidism associated with coronary spasm in a patient with acute coronary syndrome

1病例资料患者,男,58岁,因＂怕热2个月余,发作性胸闷1个月,加重1d＂入院。既往高血压病史1年,最高血压160/90mmHg（1mmHg=0.133kPa）,未经治疗。吸烟史40年（平均10支/d）;无血脂异常、糖尿病及早发冠心病家族史。体检：BP 142/80mmHg,甲状腺Ⅰ度肿大,质地中等,未闻及血管杂音。心率76次/min,心律齐,余无异常。心脏超声示正常;心电图：窦性心律,左心室高电压;Holter：窦性心律,偶发房性期前收缩（11次）和室性期前收缩（76次）;

A 58-year-old man presented with atypical chest pain without specific characteristics of thyrotoxicosis,the 12-lead electrocardiogram(ECG)showed ST-segment elevation in V1-V4 leads.Initial laboratory tests were abnormal:hs-troponin T 0.015ng/ml,TT3 33.28 ng/ml↑,TT4 415.26 μg/dl↑,FT3 11.43pg/ml↑,FT4 42.87 ng/dl↑and also found the coronary angiographic evidence of severe ostial vasospasm in the left main and left circumflex coronary arteries.Subsequently,he was diagnosed with hyperthyroidism which was suspected to be the cause of the coronary spasm.The patient treated with antithyroid therapy,oral nitrates,diltiazem with resolution of his symptoms.This unusual case highlights the importance of considering hyperthyroidism in the differential diagnosis of recurrent chest pain and coronary artery spasm.We suggest routine thyroid function testing in patients with coronary spasm.