Idiopathic Hypoparathyroidism Associated with Hyperthyroidism

Dahl, James R.; McFadden, Samuel; Eisenberg, Eugene

doi:10.7326/0003-4819-57-4-635

Cited by 15 publications

(8 citation statements)

References 33 publications

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“…The prevalence of hypo-/hyperthyroidism was between 3.9 and 24% in patients with SLE and the frequency of antithyroid antibodies was between 11 and 51% (14)(15)(16). On the other hand, rare associations of hyperthyroidism with idiopathic hypoparathyroidism and hypocalcemia were advocated by some authors (17). A recent review summarized the association of idiopathic urticaria with or without angioedema with autoimmune thyroid disease (18).…”

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confidence: 99%

Graves' Disease, Hypoparathyroidism, Systemic Lupus Erythematosus, Alopecia, and Angioedema: Autoimmune Polyglandular Syndrome Variant or Coincidence?

Melcescu

Kemp

Majithia

et al. 2013

Int J Immunopathol Pharmacol

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Data on coexisting Graves' disease (GD), hypoparathyroidism, and systemic lupus erythematosus (SLE) are limited. The thyroid and parathyroid glands may be extra sensitive to irradiation damage in an underlying autoimmune condition. A 34-year-old black woman presented with tetanic-like cramps, easy skin bruising, fatigue, weight gain, nocturia and back pain. She was previously diagnosed with GD in 2001 and underwent radioiodine therapy (RAI) in 9/01 using 6 mCi. PostRAI (November 2001) she developed hypocalcemia and hypothyroidism (2/02). In 2007, SLE was diagnosed. In October 2009, s-calcium and PTH were still low at 7.1 mg/dl and 9 pg/mL, respectively, although the patient denied symptoms on vitamin D and calcium supplementation. To identify possible autoimmune damage of the parathyroids, we evaluated the presence of activating antibodies to the CaSR and also analyzed the DNA sequence of all 6 translated exons and flanking intronic sequences of her CaSR gene for a functionally significant CaSR mutation but neither was positive. The initial autoimmune damage to her thyroid and possibly parathyroid glands followed by irradiation of them seems to have contributed to her developing both hypoparathyroidism (11/01) and hypothyroidism (2002). The patient could potentially have had parathyroid autoantibodies in 2001 that disappeared by 2009 when she was tested for them. We consider that the multiple autoimmune conditions developed over the past decade of her life with the concurrent irradiation contributing to her brittle hypoparathyroidism. Select patients with GD and perhaps parathyroid autoantibodies with a slowly developing destructive impact on the parathyroid glands may then develop overt hyoparathyroidism with rather low dose RAI ablation. This patient adds to the evolving spectrum of polyglandular syndrome variants.Here, we report a patient presenting with an interesting sequential combination of Graves' disease (GD), hypoparathyroidism, alopecia, and systemic lupus erythematosus (SLE). Hypocalcemia

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confidence: 99%

Graves' Disease, Hypoparathyroidism, Systemic Lupus Erythematosus, Alopecia, and Angioedema: Autoimmune Polyglandular Syndrome Variant or Coincidence?

Melcescu

Kemp

Majithia

et al. 2013

Int J Immunopathol Pharmacol

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“…Hypocalcemia is an exceedingly rare complication of hyperthyroidism. Seven cases of Graves' disease with hypocalcemia have been reported in the literature (2)(3)(4)(5)(6)(7)(8). None of these patients had a history of neck surgery or radioiodine therapy.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, hypocalcemia is an extremely rare association of uncomplicated hyperthyroidism. To our knowledge, only seven such cases have been reported (2)(3)(4)(5)(6)(7)(8). We report an additional case of hyperthyroidism with severe hypocalcemia.…”

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confidence: 99%

Thyroids crisis associated with severe hypocalcemia.

et al. 1991

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A 30-year-old womanwith thyroid crisis and impaired renal function presented with severe hypocalcemia. She had already had hypocalcemia one yr previously when her serum creatinine level was normal. A normal level of serum amino terminal fragment of parathyroid hormone in spite of severe hypocalcemia suggested impairment of parathyroid function. Since her serum magnesiumwas normal and she had no history of neck surgery or radioiodine therapy, her hypoparathyroidism was considered to be idiopathic. This is the seventh case with co-existing Graves' disease and idiopathic hypoparathyroidism reported in the literature.

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“…There are also studies in which there were concomitant thyroid and PTG changes presumed to be of an autoimmune mechanism common to both glands. These include Riedel's struma with fibrosis of both glands, 41 Down's syndrome with Graves’ disease and hypoparathyroidism, 42 and the same combination in adults 43–45 . On the other hand, Hashimoto's disease of the thyroid has been associated with hyperparathyroidism 46 .…”

Section: Age‐dependent Changes In the Physiology Of The Calciostatmentioning

confidence: 99%

“…In the younger population it includes Di George's syndrome, a congenital absence of the parathyroids, the autosomal recessive MEDAC, and the Hypoparathyroid‐Addison's Disease‐Candidiasis (HAM) syndromes. These syndromes are of interest here because they exhibit the aforementioned immune responses to the involved endocrine glands 42,43 . Late in the lifespan there are sporadic cases of MEDAC, with some exhibiting hypoparathyroidism 63 …”

Section: Parathyroid Aging and Parathyroid Disease—a Continuum?mentioning

confidence: 99%