Recurrent vasodilator-refractory acute coronary syndrome as the exclusive manifestation of Graves disease.

Whether recurrent acute coronary syndrome could be the exclusive manifestation of Graves disease remains unreported. We describe a premenopausal woman who had angiographically normal coronary arteries yet had 3 episodes of acute coronary events in forms of unstable angina, ST elevation, and non-ST elevation myocardial infarction despite the active therapy of calcium-channel blockade. She was finally diagnosed as with Graves disease, treated with antithyroid medication, and free from any angina relapse for up to 18 months. Thus, recurrent coronary events might be the only manifestation of subclinical hyperthyroidism in patients with angiographically normal coronary arteries and could only be prevented by antithyroid agents instead of conventional vasodilators.