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Case ReportOpen Access
Painless Thyroiditis Complicating with Hypercalcemic Encephalopathy
Thewjitcharoen Y 
,
Lumlertgul N
,
Lumlertgul N Background: Severe hypercalcemia has rarely been reported in patients with hyperthyroidism. Although the pathogenesis is
not clear, it is believed to be due to activation of osteoclasts resulting in excessive bone resorption.
Objective: To recognize the unusual cause of hypercalcemia from painless thyroiditis, which could manifest with transient
hyperthyroidism in the early stage.
Case Report: A 70-year-old woman presented with watery diarrhea, nausea and vomiting and significant weight loss for two
months. Initially, she was misdiagnosed as having Graves’ disease from her clinical presentation and thyroid function tests.
Oral propylthiouracil was given to treat hyperthyroidism. However, two weeks after discharge, she developed altered
consciousness due to severe hypercalcemia. After combined treatment of hypercalcemia and severe hyperthyroidism, her
symptoms resolved quickly. Later on, her thyroid function tests switched to subclinical hypothyroid at two months after initial
presentation. No concurrent pathological conditions could be found to explain the other causes of hypercalcemia. Therefore,
painless thyroiditis complicated with severe hypercalcemia was subsequently diagnosed based on her clinical course.
Conclusion: Hypercalcemic encephalopathy is an uncommon manifestation of hyperthyroidism that should be kept in mind
in patients who demonstrated clinical pictures of hyperthyroidism and alteration of consciousness. Moreover, the present case
emphasizes the consideration of painless thyroiditis as a differential diagnosis of hyperthyroidism because anti-thyroid
medications were not indicated in this condition.
Keywords: Painless thyroiditis, Hypercalcemic Encephalopathy, Hyperthyroidism, Hypercalcemia
not clear, it is believed to be due to activation of osteoclasts resulting in excessive bone resorption.
Objective: To recognize the unusual cause of hypercalcemia from painless thyroiditis, which could manifest with transient
hyperthyroidism in the early stage.
Case Report: A 70-year-old woman presented with watery diarrhea, nausea and vomiting and significant weight loss for two
months. Initially, she was misdiagnosed as having Graves’ disease from her clinical presentation and thyroid function tests.
Oral propylthiouracil was given to treat hyperthyroidism. However, two weeks after discharge, she developed altered
consciousness due to severe hypercalcemia. After combined treatment of hypercalcemia and severe hyperthyroidism, her
symptoms resolved quickly. Later on, her thyroid function tests switched to subclinical hypothyroid at two months after initial
presentation. No concurrent pathological conditions could be found to explain the other causes of hypercalcemia. Therefore,
painless thyroiditis complicated with severe hypercalcemia was subsequently diagnosed based on her clinical course.
Conclusion: Hypercalcemic encephalopathy is an uncommon manifestation of hyperthyroidism that should be kept in mind
in patients who demonstrated clinical pictures of hyperthyroidism and alteration of consciousness. Moreover, the present case
emphasizes the consideration of painless thyroiditis as a differential diagnosis of hyperthyroidism because anti-thyroid
medications were not indicated in this condition.
Keywords: Painless thyroiditis, Hypercalcemic Encephalopathy, Hyperthyroidism, Hypercalcemia
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