Hypothyroidism can present in a number of ways, one of which is cardiac abnormalities. Some of the cardiac manifestations include sinus bradycardia, low voltage ECG and decrease in cardiac contractility, pericardial effusion, prolonged QT interval and even Torsades de pointes in a few reported cases. It is rare for a patient to present with a clinical presentation suggestive of possible acute coronary syndrome (ACS) secondary to uncontrolled hypothyroidism. In this case report, we present a 61 year old male with history of hypothyroidism, who presented to the Emergency Department with acute onset dizziness and chest pressure. ECG done in the Emergency Department showed T wave inversions in lateral and inferior leads. The initial diagnosis was considered to be ACS as troponins were found to be slightly elevated. It was later discovered that patient’s presentation and ECG changes were secondary to hypothyroidism both of which corrected after administration of levothyroxine.