Coronary artery spasm due to thyrotoxicosis.

A 50-year-old lady presented with chest pain, tremor, weight loss and intermittent ST elevation in her ECG associated with elevated markers of myocardial injury. She was diagnosed with Graves' disease and coronary angiogram showed normal coronary arteries. It was felt coronary artery spasm secondary to thyrotoxicosis was the cause for her ECG changes and pain. She was successfully treated with diltiazem, metoprolol and carbimazole. This case highlights the importance of considering hyperthyroidism in the diagnosis of chest pain with normal coronary arteries.