Concurrent hyperthyroidism and hyperparathyroidism

Abstract

THE occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rarity and presents a specially interesting diagnostic problem since both diseases can cause loss of calcium from the body. Such a problem is presented here; there are 17 previously documented examples i n the literature (Breuer and McPherson, 1966). CASE REPORTMrs. E. S., aged 32, first presented with acute bronchitis in March, 1967, when hypercalcaemia was detected on routine investigation. There was an additional history of insomnia, weight-loss, loose motions, and irritability. I n June, 1967, she was admitted again with a diagnosis of hyperthyroidism which was confirmed on investigation.Examination revealed a thyroid enlargement estimated at 40 g., firm and with no bruits to be heard. Investigations revealed the following: FBI, 11.1 pg. per IOO ml.(normal 3'5-7'5 pg. per IOO d.); PBI3lI (48 hours), 1.07 per cent (normal 0.1-0.4 per cent); T. index (Russell Fraser), 53.2 (normal 2.8-13.0); 1311 uptake, neck uptake (48 hours), 70.8 per cent; thyroid antibodies, negative; serum calcium, 5.7 mEq. (mean of six estimations) (normal, 4'5-5.5 mEq.). The hypercalcaemia was not suppressed by cortisone administration; her serum calcium values at the end of 10 days (150mg. per day) remained higher than her previous level. Serum inorganic phosphorus was 1.7 mg. (mean of six estimations) (normal 1.6-2.4 mg.); alkaline phosphatase, 9 King-Armstrong units (normal 4-11); strontium space, 19'5 plasma units (normal (18); phosphate excretion index, basal + 0.07, +0.13 (normal *o.og); urinary calcium, 25 mEq. in 24 hours (normal <IS).The patient was given carbimazole 10 mg. 8-hourly with a Door rewonse. The serum calcium remained