Proximal Myopathy With Hypercalcemic Crisis and Papillary Thyroid Carcinoma in a 38-Year-Old Female

Although proximal myopathy is a well-known manifestation of primary hyperparathyroidism (PHP), it is usually not the first one. Here, we present the case of a 38-year-old female who presented to the neurology outpatient department with proximal myopathy as the presenting feature of PHP along with a hypercalcemic crisis. Her serum calcium and intact parathyroid hormone levels were very high. Her symptoms and calcium levels improved with adequate hydration and bisphosphonate therapy. Ultrasonography of the thyroid and parathyroid glands and Tc99m sestamibi single-photon emission computed tomography-computed tomography of the parathyroid glands suggested adenoma or carcinoma of the parathyroid gland on the right side with another irregular right-sided thyroid nodule. Electromyography showed low-amplitude polyphasic potentials suggestive of myopathy. Subsequently, the patient underwent surgical resection of both the right parathyroid glands and the thyroid nodule. Histopathology report was suggestive of parathyroid adenoma and papillary thyroid carcinoma. Hypercalcemic crisis is a rare clinical scenario, which needs prompt diagnosis and treatment. Otherwise, the condition may have a fatal outcome. Due to its diverse presentation, physicians should be aware of this condition. Moreover, we need to be cautious in treating a patient having hyperparathyroidism with thyroid nodule due to possible concomitant thyroid malignancy.