{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:56:16Z","timestamp":1770738976477,"version":"3.49.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Hyperthyroidism-induced hypercalcemia has been reported previously, but hypercalcemia accompanied by severe osteoporosis and significant thymic enlargement in patients with hyperthyroidism is quite rare. We report the coexistence of hypercalcemia, osteoporosis and thymic enlargement in a patient with Graves\u2019 disease.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>A 22-year-old female was diagnosed as Graves\u2019 disease with obviously elevated serum calcium and reduced parathyroid hormone levels. Dual-energy x-ray absorptiometry and chest enhanced computer tomography (CT) revealed severe osteoporosis and a significant enlargement of thymus. After the successful control of hyperthyroidism with methimazole, hypercalcemia was corrected, bone mineral density was improved and thymus also shrank obviously.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This is a very rare case of hypercalcemia accompanied by severe osteoporosis and significant thymic enlargement induced by Graves\u2019 disease. In clinical practice, examination of thymus and bone density should be considered when a patient with Graves\u2019 disease was present with hypercalcemia.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12902-020-00583-8","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T07:02:49Z","timestamp":1593500569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The coexistence of hypercalcemia, osteoporosis and thymic enlargement in graves\u2019 disease: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Dandan","family":"Yan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanjun","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lian-Xi","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"issue":"5","key":"583_CR1","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1530\/EJE-10-1172","volume":"164","author":"J Wiebolt","year":"2011","unstructured":"Wiebolt J, Achterbergh R, den Boer A, et al. Clustering of additional autoimmunity behaves differently in Hashimoto's patients compared with Graves' patients. Eur J Endocrinol. 2011;164(5):789\u201394.","journal-title":"Eur J Endocrinol"},{"issue":"12","key":"583_CR2","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s40618-014-0157-7","volume":"37","author":"M Dalla Costa","year":"2014","unstructured":"Dalla Costa M, Mangano FA, Betterle C. Thymic hyperplasia in patients with Graves' disease. J Endocrinol Investig. 2014;37(12):1175\u20139.","journal-title":"J Endocrinol Investig"},{"issue":"8","key":"583_CR3","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1089\/thy.2017.0086","volume":"27","author":"U Haider","year":"2017","unstructured":"Haider U, Richards P, Gianoukakis AG. Thymic hyperplasia associated with Graves' disease: pathophysiology and proposed management algorithm. Thyroid. 2017;27(8):994\u20131000.","journal-title":"Thyroid."},{"issue":"4","key":"583_CR4","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1089\/105072504323030979","volume":"14","author":"T Nakamura","year":"2004","unstructured":"Nakamura T, Murakami M, Horiguchi H, et al. A case of thymic enlargement in hyperthyroidism in a young woman. Thyroid. 2004;14(4):307\u201310.","journal-title":"Thyroid."},{"issue":"6","key":"583_CR5","doi-asserted-by":"publisher","first-page":"673","DOI":"10.2169\/internalmedicine.51.7076","volume":"51","author":"S Nakamura","year":"2012","unstructured":"Nakamura S. Thymic enlargement in two cases of Graves' disease. Intern Med. 2012;51(6):673\u20134.","journal-title":"Intern Med"},{"issue":"4","key":"583_CR6","doi-asserted-by":"publisher","first-page":"e6017","DOI":"10.1097\/MD.0000000000006017","volume":"96","author":"K Chen","year":"2017","unstructured":"Chen K, Xie Y, Zhao L, Mo Z. Hyperthyroidism-associated hypercalcemic crisis: a case report and review of the literature. Medicine (Baltimore). 2017;96(4):e6017.","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"583_CR7","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s40618-017-0753-4","volume":"41","author":"GR Williams","year":"2018","unstructured":"Williams GR, Bassett JHD. Thyroid diseases and bone health. J Endocrinol Investig. 2018;41(1):99\u2013109.","journal-title":"J Endocrinol Investig"},{"issue":"10","key":"583_CR8","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1056\/NEJMc0707309","volume":"358","author":"L Giovanella","year":"2008","unstructured":"Giovanella L, Suriano S, Ceriani L. Graves' disease, thymus enlargement, and hypercalcemia. N Engl J Med. 2008;358(10):1078\u20139.","journal-title":"N Engl J Med"},{"issue":"8","key":"583_CR9","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1210\/jc.2011-0247","volume":"96","author":"AD Benaderet","year":"2011","unstructured":"Benaderet AD, Burton AM, Clifton-Bligh R, Ashraf AP. Primary hyperparathyroidism with low intact PTH levels in a 14-year-old girl. J Clin Endocrinol Metab. 2011;96(8):2325\u20139.","journal-title":"J Clin Endocrinol Metab"},{"issue":"Suppl 1","key":"583_CR10","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s12893-018-0459-3","volume":"18","author":"F Medas","year":"2019","unstructured":"Medas F, Erdas E, Loi G, et al. Intraoperative parathyroid hormone (PTH) testing in patients with primary hyperparathyroidism and PTH levels in the normal range. BMC Surg. 2019;18(Suppl 1):124.","journal-title":"BMC Surg"},{"issue":"3","key":"583_CR11","doi-asserted-by":"publisher","first-page":"429","DOI":"10.7326\/0003-4819-65-3-429","volume":"65","author":"JD Baxter","year":"1966","unstructured":"Baxter JD, Bondy PK. Hypercalcemia of thyrotoxicosis. Ann Intern Med. 1966;65(3):429\u201342.","journal-title":"Ann Intern Med"},{"issue":"6","key":"583_CR12","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1007\/s00198-010-1421-0","volume":"22","author":"CS Ryan","year":"2011","unstructured":"Ryan CS, Petkov VI, Adler RA. Osteoporosis in men: the value of laboratory testing. Osteoporos Int. 2011;22(6):1845\u201353.","journal-title":"Osteoporos Int"},{"issue":"10","key":"583_CR13","first-page":"428","volume":"66","author":"AC van de Ven","year":"2008","unstructured":"van de Ven AC, Erdtsieck RJ. Changes of bone mineral density, quantitative ultrasound parameters and markers of bone turnover during treatment of hyperthyroidism. Neth J Med. 2008;66(10):428\u201332.","journal-title":"Neth J Med"},{"issue":"7363","key":"583_CR14","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/S0140-6736(64)90558-6","volume":"2","author":"A Gunn","year":"1964","unstructured":"Gunn A, Michie W, Irvine WJ. The Thymus in Thyroid Disease. Lancet. 1964;2(7363):776\u20138.","journal-title":"Lancet."},{"key":"583_CR15","first-page":"18","volume":"2019","author":"C Kamath","year":"2019","unstructured":"Kamath C, Witczak J, Adlan MA, Premawardhana LD. Managing thymic enlargement in Graves' disease. Endocrinol Diabetes Metab Case Rep. 2019;2019:18\u20130119.","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"issue":"8","key":"583_CR16","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1369\/jhc.4A6548.2005","volume":"53","author":"M Gessi","year":"2005","unstructured":"Gessi M, Monego G, Lauriola L, Maggiano N, Ranelletti FO. Parathyroid hormone-related peptide (hPTHrP) and parathyroid hormone-related peptide receptor type 1 (PTHR1) expression in human thymus. J Histochem Cytochem. 2005;53(8):955\u201362.","journal-title":"J Histochem Cytochem"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-020-00583-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-020-00583-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-020-00583-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T23:15:43Z","timestamp":1625008543000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-020-00583-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,30]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["583"],"URL":"https:\/\/doi.org\/10.1186\/s12902-020-00583-8","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,30]]},"assertion":[{"value":"20 January 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We have obtained a written informed consent from the patient for this manuscript.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained by the patient for the publication of this case report and any accompanying images.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflicts of interest to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"97"}}