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2014, Number 6

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AMC 2014; 18 (6)

Hypercalcemia associated to Graves’ disease

Pila PR, Rosales TP, Pila PR, Artola GJ

Language: Spanish
References: 25
Page: 680-694
PDF size: 362.98 Kb.


ABSTRACT

Background: among the causes of spontaneous thyrotoxicosis, Graves’ disease is the most common and represents a 60-90 % of all causes of thyrotoxicosis in different regions in the world. It is considered one of the prototypes of organspecific autoimmune disease. Hypercalcemia is an infrequent event in Graves’ disease; although it can result from an excess of calcium entrance in the extracelular fluid or from insufficient excretion, in the case of Graves disease the exact mechanism for its appearance is unknown.
Objective: to present the case of a patient with Graves’ disease associated to serious hypercalcemia, unusual for this disease. A case of thyrotoxicosis with multiple manifestations of this disease, associated to signs and symptoms of serious hypercalcemia (hypercalcemic crisis) is described.
Clinical case: a twenty-six-year-old patient who starts presenting common manifestations of thyrotoxicosis and non-suspect associated hypercalcemia. Functional tests of the thyroid, laboratory tests and the tests from the clinic confirmed the diagnosis of Graves’ disease with a hypercalcemic crisis. The therapeutics employed turned out to be satisfactory, being the patient asymptomatic with persistence of exophthalmos.
Conclusions: clinical manifestations were fundamental to suspect Graves’ disease. Hypercalcemia is an infrequent element in this endocrine disease. The appearance of a hypercalcemic crisis can trigger serious complications for the patient, being an exceptional event in patients with thyrotoxicosis. The hypercalcemia suppression test with steroids is very useful from the clinical point of view in its association with thyrotoxicosis to rule out the possibility of concurrent hyperparathyroidism.


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