Painless thyroiditis complicating with hypercalcemic encephalopathy.

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Severe hypercalcemia is rarely associated with hyperthyroidism, potentially due to increased osteoclast activity and bone resorption.
• The exact pathogenesis linking hyperthyroidism and hypercalcemia remains unclear.

Observation:

• A 70-year-old woman presented with symptoms of hyperthyroidism, including diarrhea, nausea, vomiting, and weight loss.
• She was initially misdiagnosed with Graves' disease and treated with propylthiouracil.
• Following treatment, she developed altered consciousness due to severe hypercalcemia.

Findings:

• The patient's condition resolved after treatment for both hypercalcemia and hyperthyroidism.
• Thyroid function tests later normalized, indicating a transient hyperthyroid phase.
• Painless thyroiditis was diagnosed as the underlying cause of hypercalcemia, as other causes were excluded.

Implications:

• Hypercalcemic encephalopathy can be an uncommon manifestation of hyperthyroidism, necessitating consideration in patients with altered consciousness.
• Painless thyroiditis should be considered in the differential diagnosis of hyperthyroidism, as it does not require anti-thyroid medication.