Journal List > J Korean Soc Endocrinol > v.21(3) > 1063865

Choi, Lee, Chung, Park, Lee, Won, Kim, and Kim: A Case of Hyperthyroidism Associated with Symptomatic Hypercalcemia


Two of the common causes of hypercalcemia are malignancy and primary hyperparathyroidism. These disorders are easily diagnosed by the clinical manifestations and measurement of the serum intact parathyroid hormone (PTH) level. On the other hand, hyperthyroidism is an uncommon cause of hypercalcemia. The diagnosis of hypercalcemia associated with hyperthyroidism can only be made by excluding the common causes of hypercalcemia and by observing the improvement of the hypercalcemia and its associated symptoms with normalizing the thyroid function.
Herein we reported our experience with a 67 year-old woman who presented with nausea and vomiting. She showed elevated serum calcium and phosphorus levels. Serum intact PTH level was 1.1 pg/mL (normal range; 10~65). The results of the thyroid function test were compatible with hyperthyroidism. After resolution of the thyrotoxicosis with combination treatment of methimazol and Lugol's solution, the patient's serum calcium and phosphorus levels were normalized and the symptoms were improved.

Figures and Tables

Fig. 1
Bone mineral density at initial diagnosis.
Fig. 2
Technetium-99m thyroid scan shows diffuse enlargement with homogenous increased uptake of 16.1%.
Fig. 3
Serial measurements of calcium and phosphorous.
Table 1
Change of laboratory profile during management of hyperthyroidism

HD: Hospital day, OPD: Out Patient Department


1. Potts JT, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. 2005. 16th Ed. New York: McGraw-Hill Professional;2249.
2. Christensson T, Hellstrom K, Wengle B, Alveryd A, Wikland B. Prevalence of hypercalcemia in a health screening in Stockholm. Acta Med Scand. 1976. 200:131–137.
3. Stewart AF. Endocrine causes of hypercalcemia other than primary hyperparathyroidism. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 1993. 2nd Ed. New York: Raven Press;184–185.
4. Hui WH, Lee CY. Hypercalcemia and hypertransaminasaemia in a child with hyperthyroidism. J Paediatr Child Health. 2004. 40:646–648.
5. Park HY, Kim WB, Kim HK, Shin CS, Kim SY, Cho BY, Lee HK, Koh CS. A case of symptomatic severe hypercalcemia as initial manifestation of hyperthyroidism. J Kor Soc Endocrinol. 1996. 11:124–126.
6. Auwerx J, Bouillon R. Mineral and bone metabolism in thyroid disease: A review. Q J Med. 1986. 60:737–752.
7. Daly JG, Greenwood RM, Himsworth RL. Serum calcium concentration in hyperthyroidism at diagnosis and after treatment. Clin Endocrinol (Oxf). 1983. 19:397–404.
8. Park JM, Kim GL, Pyun HY, Cho SR, Yeo JK, Park KY, Hur JW. The incidence and causes of hypercalcemia in a hospital population. J Kor Soc Endocrinol. 1993. 8:72–77.
9. Maxon HR, Apple DJ, Goldsmith RE. Hypercalcemia in thyrotoxicosis. Surg Gynecol Obstet. 1978. 147:694–696.
10. McGowan DM, Vaswani A, Shperling I. Coexisting hyperparathyroidism with thyrotoxicosis. J Endocrinol Invest. 1991. 14:305–310.
11. Buckle RM, Mason AMS, Middleton JE. Thyrotoxic hypercalcemia treated with porcine calcitonin. Lancet. 1969. 1:1128–1130.
12. Guyer PB. Hypercalcemia in thyrotoxicosis. Br Med J. 16. 5428:169.
13. Harper PS, Hughes RO. Severe hypercalcemia from hyperthyroidism with unusual features. Br Med J. 1970. 1:213–214.
14. Hedman I, Tisell LE. Life-threatening hypercalcemia in a case of thyrotoxicosis: clinical features and management. A case report. Acta Chir Scand. 1985. 151:487–489.
15. Chow KM, Szeto CC. An unusual cause of hypercalcemia. South Med J. 2004. 97:588–589.
16. Twycross RG, Marks V. Symptomatic hypercalcemia in thyrotoxicosis. Br Med J. 1970. 2:701–703.
17. Alikhan Z, Singh A. Hyperthyroidism manifested as hypercalcemia. South Med J. 1996. 89:997–998.
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