Angina in thyrotoxicosis. Thyroid-related coronary artery spasm

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. A case is reported of angina and thyrotoxicosis in which the angina was reproduced by coronary artery spasm induced by ergonovine maleate, relieved by thyroid ablation, and reactivated by postablative thyroid replacement. Coronary arteriography did not show significant stenoses prior to ergonovine injection. Possible mechanisms of coronary artery spasm in thyrotoxicosis are briefly discussed. Hyperthyroidism should be considered as a cause of angina in any patient with rest pain and normal coronary arteries.