Hypercalcemic Crisis due to Primary Hyperparathyroidism Occurring Concomitantly with Graves' Disease

Yokomoto, Maki; Minamoto, Mayu; Utsunomiya, Daisuke; Umakoshi, Hironobu; Fukuoka, Tatsunari; Kondo, Shin‐ichiro

doi:10.2169/internalmedicine.54.2605

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…[ 2 , 20 ] In addition, some hormones, such as adrenaline and glucocorticoid hormones, are dysregulated under hyperthyroid conditions, thereby contributing to a hypercalcemic state. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] To date, only 3 cases of hyperthyroidism complicated with hypercalcemic crisis have been reported. [ 6 – 8 ] One case was complicated with hyperparathyroidism and the another was with serum calcium of 3.0 mmol/L. [ 6 , 7 ] Endo et al [ 8 ] reported a rare case with serum calcium of 4.1 mmol/L in a patient with hyperthyroidism-associated hypercalcemia.…”

Section: Introductionmentioning

confidence: 99%

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Hyperthyroidism-associated hypercalcemic crisis

et al. 2017

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Rationale:Hyperthyroidism is one of the major clinical causes of hypercalcaemia, however, hyperthyroidism-related hypercalcemic crisis is rare, only 1 case have been reported. The potential mechanisms are still not too clear. It may be related that thyroid hormone stimulate bone turnover, elevate serum calcium, increase urinary and fecal calcium excretion.Patient concerns:A 58-year-old female patient was found to have Graves’ disease, a marked elevated serum calcium level (adjusted serum calcium: 3.74 mmol/L), and reduced parathyroid hormone level.Diagnoses:She was diagnosed as hyperthyroidism-associated hypercalcemic crisis.Interventions:Treatment with methimazole to correct the hyperthyroidism and treatment of the patient's hypercalcaemia was achieved by physiological saline, salmon calcitonin and furosemide.Outcomes:After treatment for hypercalcaemia and hyperthyroidism, her symptoms and serum calcium levels quickly returned to normal.Lessons:hyperthyroid-associated hypercalcaemia crisis is rare, however, the diagnosis should pay attention to screening for other diseases caused by hypercalcemia. Timely treatment of hypercalcaemia is a critical step for rapidly control of symptoms, and treatment of hyperthyroidism is beneficial to relief the symptoms and maintain the blood calcium level.

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“…[ 2 , 20 ] In addition, some hormones, such as adrenaline and glucocorticoid hormones, are dysregulated under hyperthyroid conditions, thereby contributing to a hypercalcemic state. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperthyroidism-associated hypercalcemic crisis

et al. 2017

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“…Th erefore, it is obvious that providing a euthyroid state preoperatively is critical for a safe surgical treatment. Besides, in a case of an hypercalcaemic crisis reported recently by Yokomoto et al (2015), primary hyperparathyroidism and thyrotixicosis was simultaneously present and an operation performed following obtaining an euthyroid and normocalcaemic state resulted in success. In the case presented in this paper, the patient was sent for surgery aft er a euthyroid, normocalcaemic state was provided and successfully treated, and similar to the previously above-stated case.…”

Section: Discussionmentioning

confidence: 96%

“…Hypercalcaemic crisis is a rare complication of primary hyperparathyroidism. Only 1.6-6% of the patients with primary hyperparathyroidism present with hypercalcaemic crisis and the hypercalcaemic crisis is produced generally secondary to other intervening co-morbidities such as pancreatitis, hyperemesis gravidarum and thyrotoxicosis (Yokomoto et al 2015). Association of primary hyperparathyroidism and thyrotoxicosis may facilitate development of hypercalcaemia and this may result in the picture of hypercalcaemic crisis.…”

Section: Discussionmentioning

confidence: 99%

A case of hypercalcaemic crisis secondary to coexistence of primary hyperparathyroidism and Graves’ disease

Baldane

İpekçi

Evcen

et al. 2016

Endocrine Regulations

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A 46 year-old female patient presented to the hospital with ongoing and progressively increasing fatigue, severe nausea and vomiting, loss of appetite, constipation, palpitations and somnolence. Laboratory evaluation revealed a severe hypercalcaemia and overt hyperthyroidism. She was diagnosed with primary hyperparathyroidism accompanied by Graves' disease. Th e patient underwent total thyroidectomy and right inferior parathyroid gland adenoma excision on the 24th day of her admission to the hospital aft er calcium levels and free thyroid hormone levels were brought to normal ranges. We suggest that a possibility of simultaneous thyrotoxicosis and primary hyperparathyroidism in cases presenting with a hypercalcaemic crisis should be considered

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“…Severe hypercalcaemia (levels above 3.5 mmol/L) is quite rare 4. There are only a few cases in the literature of hypercalcaemia secondary to hyperthyroidism 5–8. The association of thyroid hormone with calcium levels remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Severe hypercalcaemia secondary to relapsed Graves’ disease

et al. 2021

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A 21-year-old woman presented to hospital with abdominal pain and nausea. She had a history of Graves’ disease which had been effectively treated with carbimazole for 15 months. Investigations revealed a serum adjusted calcium level of 3.69 mmol/L with a suppressed parathyroid hormone, thyroid stimulating hormone <0.01 mu/L (0.2–5.0) and free T4 of 76.1 pmol/L (9-24). She was treated as a relapsed case of Graves’ disease and started on propylthiouracil. Calcium levels continued to increase over the next 3 days despite adequate fluid resuscitation. A decision was taken to administer intravenous bisphosphonate (pamidronate) which resulted in a lowering of calcium levels. She became mildly hypocalcaemic following treatment with pamidronate which was presumed secondary to low vitamin D and oral vitamin D replacement was commenced. This case was unique as this is to our knowledge the most significant hypercalcaemia observed in a patient with hyperthyroidism. All other causes of hypercalcaemia were excluded. The learning points were recognising hypercalcaemia as a complication of thyrotoxicosis and the risk of hypocalcaemia following bisphosphonate therapy with low vitamin D stores.

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Hypercalcemic Crisis due to Primary Hyperparathyroidism Occurring Concomitantly with Graves' Disease

Cited by 10 publications

References 21 publications

Hyperthyroidism-associated hypercalcemic crisis

Hyperthyroidism-associated hypercalcemic crisis

A case of hypercalcaemic crisis secondary to coexistence of primary hyperparathyroidism and Graves’ disease

Severe hypercalcaemia secondary to relapsed Graves’ disease

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