Refractory vasomotor angina in subclinical hyperthyroidism demonstrating focal and segmental coronary vasoconstriction.

We describe a case of refractory vasomotor angina in the setting of unrecognized subclinical hyperthyroidism. Despite aggressive medical therapy, frequent rest angina recurred until diagnosis and treatment of Grave s Disease, which presented asymptomatically. Both spontaneous focal vasospasm and inducible segmental coronary vasoconstriction were demonstrated during invasive provocative testing. Subclinical hyperthyroidism should be considered in the differential diagnosis when treating refractory vasomotor angina, especially in women over 50 years old, a population at particular risk for undiagnosed thyroid disease.