Hypercalcaemia as the initial presentation of Graves' disease

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Hypercalcaemia in hyperthyroidism is typically asymptomatic, linked to increased bone turnover.
• Symptomatic presentations are rare, often delaying diagnosis.

Observation:

• A middle-aged Asian man presented with intractable vomiting, initially unresponsive to antiemetics.
• Biochemical analysis revealed hypercalcaemia and concurrent hyperthyroidism.
• The patient lacked classical hyperthyroid symptoms, complicating initial diagnosis.

Findings:

• Correction of hypercalcaemia led to resolution of the patient's vomiting.
• Hypercalcaemia did not recur after achieving euthyroid status with carbimazole.
• Malignancy and other common causes of hypercalcaemia were excluded.

Implications:

• This case underscores that severe symptomatic hypercalcaemia can be the initial manifestation of hyperthyroidism.
• Prompt diagnosis and management of hyperthyroidism are crucial for resolving associated hypercalcaemia.
• Highlights the importance of considering endocrine disorders in unexplained symptomatic hypercalcaemia.