Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8127-8134
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8127
Acute coronary syndrome with severe atherosclerotic and hyperthyroidism: A case report
Hai-Mei Zhu, Yi Zhang, Yun Tang, Hua Yuan, Zhen-Xian Li, Yun Long
Hai-Mei Zhu, Department of Pain, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Yi Zhang, Zhen-Xian Li, The Graduate School, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
Yun Tang, Hua Yuan, Yun Long, Department of Cardiology, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Author contributions: Zhu HM and Zhang Y reviewed the literature and contributed to manuscript drafting; Tang Y was the patient’s cardiovascular doctor and interpreted the imaging findings; Yuan H analyzed and interpreted the imaging findings; Li ZX reviewed the literature; Long Y was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by Science and Technology Planning Project of Hunan Province, No. 2018JJ2304; and the Research Foundation of Hunan University of Chinese Medicine, No. 2019XJJJ042.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yun Long, MD, PhD, Chief Doctor, Department of Cardiology, The First Hospital of Hunan University of Chinese Medicine, No. 95 Shaoshan Road, Yuhua District, Changsha 410007, Hunan Province, China.
Received: May 9, 2021
Peer-review started: May 9, 2021
First decision: June 5, 2021
Revised: June 16, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: September 26, 2021

Acute coronary syndrome (ACS) encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia. Recent studies have revealed that thyroid function is closely related to ACS. However, only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.


A 33-year-old man, who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease, experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity. As the symptoms worsened at 21 d prior, he went to a hospital for treatment. The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves. Based on these findings and his symptoms, the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2, 2020. He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism. A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents, thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism. The 9-mo follow-up showed favorable results.


This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.

Keywords: Acute coronary syndrome, Atherosclerosis, Hyperthyroidism, Paclitaxel-coated drug balloon, Case report

Core Tip: We present a case of an acute coronary syndrome due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism in a 33-year-old man. Patients with thyrotoxicosis-induced acute coronary syndrome (ACS) are very special, and almost all reported cases have been associated with Graves’ disease. Coronary angiography usually shows zero disease, and coronary artery spasm occupies a large proportion of data, which is contradictory with this case that ACS is accompanied by atherosclerosis. In this case ,we find that intensive drug therapy and implant-free interventional therapy are better options for patients with ACS and hyperthyroidism.