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Elderly patient presenting with severe thyrotoxic hypercalcemia
Author(s) -
Kikuchi Reiko,
Mochizuki Satoru,
Shimizu Masahiko,
Sudoh Noriko,
Kozaki Koichi,
Akishita Masahiro,
Toba Kenji
Publication year - 2006
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/j.1447-0594.2006.00359.x
Subject(s) - medicine , bone resorption , discontinuation , osteoporosis , endocrinology , calcitonin , anorexia , thyroid function , exacerbation , hyperparathyroidism , parathyroid hormone , thyroid , gastroenterology , calcium
An 81‐year‐old woman with Graves’ disease and osteoporosis was referred to the hospital because of anorexia over one month and impaired consciousness. She also presented with low‐grade fever and emaciation. Laboratory tests revealed marked hypercalcemia (corrected serum calcium level of 12.4 mg/dL), which was initially suspected to result from vitamin D toxicity, because she had been taking vitamin D3 (alphacalcidol of 0.5 µg/day) for the treatment of osteoporosis. However, discontinuation of vitamin D3 and fluid infusion did not ameliorate hypercalcemia one week later. After excluding hyperparathyroidism and malignancy‐related hypercalcemia, hypercalcemia was considered to be attributable to the exacerbation of hyperthyroidism (free T4 of 6.69 ng/dL, free T3 of 13.27 pg/mL and thyroid stimulating hormone (TSH) <0.015 µIU/mL) with increased bone resorption. Finally, the increased dose of thiamazole (30 mg/day) normalized serum calcium level and thyroid function three months later. Laboratory tests suggested that normal bone formation in spite of increased bone resorption contributed to hypercalcemia in hyperthyroid state.