Abstract: SA-PO515
Bones, Groans, and Thyroid Hormones: A Rare Case of Hyperthyroidism Induced Hypercalcemic Crisis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders
- 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical
Authors
- Siddiqui, Neha, AtlantiCare Regional Medical Center, Atlantic City, New Jersey, United States
- Sinha, Ram, AtlantiCare Regional Medical Center, Atlantic City, New Jersey, United States
- Kohli, Jatinder, AtlantiCare Regional Medical Center, Atlantic City, New Jersey, United States
Introduction
Mild to moderate hypercalcemia can be seen in patients with hyperthyroidism, but serum calcium levels rarely exceed more than 12mg/dl. The mechanism of hyperthyroidism-induced hypercalcemia is not fully understood. However, it is proposed that an elevation in thyroid hormone can stimulate bone turnover and, therefore, cause an increase in serum and urine calcium levels with subsequent suppression of PTH levels.
Case Description
A 36-year-old male with a past medical history of IV drug use, hypertension, and untreated hyperthyroidism presented to the emergency department with increasing dyspnea, non-productive cough, dizziness, nausea and vomiting for three days. The patient also endorsed palpitations, hot flashes, and weight loss over the last few months. No known family history of thyroid disease, hypercalcemia, or malignancy. Physical examination was remarkable for tachycardia and tremors. His labs were significant for a corrected calcium of 12.2mg/dl and TSH <0.005. Serum creatinine was within normal limits. UDS was unremarkable, PTH was suppressed, the PTHrP was normal, vitamin D levels were low, and SPEP was unremarkable. The patient received a 2L fluid bolus in the emergency department and was started on maintenance IVF. Upon further investigation, the patient had T3 of >20, elevated free T4 >7.77, Thyroxine (T4) of 23.8, TSIG, and thyroid receptor antibody were positive. NM bone scan showed no osteolytic or osteoblastic lesions. The patient received calcitonin for two days while conducting hypercalcemia workup. The patient was on IV steroids for a brief period of time as treatment for possible thyroid storm. The patient was started on methimazole and propranolol, both of which were continued upon discharge. Serum calcium levels and symptoms responded to treatment.
Discussion
To the best of our knowledge, there are four reported cases of hyperthyroidism-induced hypercalcemic crises with a serum calcium level of 12mg/dl (3mmol/dl) or more. We present a case of a 36-year-old male with symptomatic hypercalcemia with a calcium level of 12.2 upon arrival. Although rare, hyperthyroidism should be considered a cause when all other etiologies of hypercalcemic crisis have been ruled out. Immediate volume expansion and treatment with anti-thyroid medications are the mainstay of management of hyperthyroidism-induced hypercalcemia.