Hypercalcaemia and hypertransaminasaemia in a child with hyperthyroidism

Unusual Etiology of Hypercalcemia in an Adolescent With Acute Gastroenteritis

We present the report of an adolescent female who presented with acute gastroenteritis, weight loss, and hypercalcemia. Further evaluation revealed hyperthyroidism to be the cause of hypercalcemia. Treatment of hyperthyroidism successfully corrected the hypercalcemia in our index case.

Hypocalcemia following treatment with radioiodine in a child with Graves' disease

BACKGROUND

Hypocalcemia is a rarely recognized complication of (131)I therapy that has been previously reported in only one child with Graves' disease treated with radioiodine (RAI). Here we report a second child with this occurrence.

PATIENT FINDINGS

A 12-year-old African American girl with hyperthyroidism due to Graves' disease and moderate persistent asthma, requiring oral prednisone, was treated with 11.1 mCi of RAI. While normocalcemic initially, the patient developed symptomatic hypocalcemia (6.6 mg/dL), within 3 months postablation. Concomitant findings included hyperphosphatemia, an inappropriately normal parathyroid hormone (PTH) level, vitamin D deficiency, and normal axial bone mineral density. After 2 weeks of treatment with calcium and calcitriol the symptoms of hypocalcemia resolved, and the calcium level returned to normal. PTH levels remained within the reference range throughout.

SUMMARY

In this child with Graves' disease, who was normocalcemic on presentation, RAI treatment was followed by compromised function of the parathyroid glands which was sufficient to produce symptomatic hypocalcemia. It is noteworthy and likely pertinent that the patient had a background of vitamin D deficiency and was receiving prednisone for asthma.

CONCLUSION

Patients scheduled to receive (131)I should be evaluated for risk factors for hypocalcemia in order to minimize the likelihood of this potentially serious complication.