title: Thyrotoxicosis-induced acute myocardial infarction due to painless thyroiditis.
abstract: BACKGROUND
  Thyrotoxicosis influences cardiovascular hemodynamics and can induce coronary vasospasm. Patients with thyrotoxicosis-induced acute myocardial infarction (AMI) are unusual and almost all reported cases have been associated with Graves' disease. Patients with painless thyroiditis show a thyrotoxic phase during the early stages. Here we describe a very rare case of thyrotoxicosis with painless thyroiditis-induced AMI.
  
  
  CONCLUSIONS
  A 35-year-old Korean man visited the emergency room for a 2-hour duration of typical AMI chest pain. The patient did not have any coronary artery disease (CAD) risk factors. The electrocardiogram showed 3 mm of ST-segment elevation in leads II, III, and aVF, which is consistent with inferior AMI. We immediately treated the patient with aspirin, clopidogrel, and nitroglycerine and performed emergent coronary angiography. Coronary angiography showed normal coronary arteries without any stenotic lesions. Consistent with AMI, cardiac enzyme levels of serum creatine kinase (CK), CK-MB, and troponin-I were also elevated. Laboratory findings showed thyrotoxicosis without any thyroid autoantibodies. A 99m-technetium scintigraphy showed markedly decreased thyroid uptake compatible with thyroiditis. We treated the patient with calcium channel blockers and nitrates. The patient spontaneously recovered normal thyroid function after 6 weeks of observation and did not complain of chest pain.
  
  
  CONCLUSIONS
  Thyrotoxicosis due to painless thyroiditis provoked AMI in a young man who had no atherosclerotic coronary lesions and no CAD risk factors.
authors.affiliation: Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, South Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Jung
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.forename: Seok-Jae
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Jung
authors.forename: Soo Kyoung
authors.initials: SK
authors.lastname: Kim
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Chung
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D009566:Nitrates / Q000627:therapeutic use; D011877:Radionuclide Imaging; D013966:Thyroiditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D013971:Thyrotoxicosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D009566:Nitrates