{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:23:31Z","timestamp":1790022211563,"version":"4.0.1"},"reference-count":16,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,23]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>A 21-year-old woman presented to hospital with abdominal pain and nausea. She had a history of Graves\u2019 disease which had been effectively treated with carbimazole for 15 months. Investigations revealed a serum adjusted calcium level of 3.69\u2009mmol\/L with a suppressed parathyroid hormone, thyroid stimulating hormone &lt;0.01\u2009mu\/L (0.2\u20135.0) and free T4 of 76.1\u2009pmol\/L (9-24). She was treated as a relapsed case of Graves\u2019 disease and started on propylthiouracil. Calcium levels continued to increase over the next 3\u2009days despite adequate fluid resuscitation. A decision was taken to administer intravenous bisphosphonate (pamidronate) which resulted in a lowering of calcium levels. She became mildly hypocalcaemic following treatment with pamidronate which was presumed secondary to low vitamin D and oral vitamin D replacement was commenced. This case was unique as this is to our knowledge the most significant hypercalcaemia observed in a patient with hyperthyroidism. All other causes of hypercalcaemia were excluded. The learning points were recognising hypercalcaemia as a complication of thyrotoxicosis and the risk of hypocalcaemia following bisphosphonate therapy with low vitamin D stores.<\/jats:p>","DOI":"10.1136\/bcr-2020-238898","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T12:11:22Z","timestamp":1610971882000},"page":"e238898","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Severe hypercalcaemia secondary to relapsed Graves\u2019 disease"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1693-2051","authenticated-orcid":false,"given":"Haris","family":"Khan","sequence":"first","affiliation":[{"name":"Diabetes and Endocrinology, Manchester Royal Infirmary, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maimoona","family":"Nawaz","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Royal 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