Spontaneous multivessel coronary artery dissection associated with microaneurysms in a young women with thyroiditis background: Unusual case report

Spontaneous coronary artery dissection (SCAD) is a rare condition that is frequently under-recognized. It has been connected to several triggers and predisposing factors. Interestingly, hypothyroidism has been linked to a higher likelihood of arterial dissections. We present the case of a 49-year-old woman who was admitted for acute coronary syndrome. Coronary angiography revealed signs of SCAD affecting the distal left anterior descending artery and the right ventricular branch. Additionally, microaneurysms were detected in the distal circumflex artery, the main septal artery, and a branch of the distal right coronary artery. During her hospitalization, a goiter was identified, and further evaluation confirmed autoimmune thyroiditis. The patient was managed with conservative treatment. A follow-up angiogram 6 months later showed that the previously dissected coronary segments and microaneurysms had regressed. This case highlights the possible role of hypothyroidism in increasing risk of SCAD and possibly microaneurysms which has been suggested in only isolated cases in the literature. It also demonstrates the effectiveness of a conservative treatment approach for this condition.