{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:20:56Z","timestamp":1770744056612,"version":"3.49.0"},"reference-count":4,"publisher":"IMR Press","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hospital Medicine"],"published-print":{"date-parts":[[1999,4]]},"abstract":"<jats:p>A45-year-old man was referred to the surgical assessment unit by his GP with a 1-week history of vomiting and severe abdominal pain. Marked tenderness was noted in the epigastrium and umbilical region. He was dehydrated with blood pressure 100\/70 mmHg and pulse of 110\/min. The rest of the initial examination was normal. Abdominal and chest X-ray, electrocardiogram, routine blood tests, including full blood count, liver and kidney functions, cardiac enzymes and serum amylase were normal as were the ultrasound scan of the abdomen and endoscopy of stomach and duodenum. Serum calcium was very high at 3.11 mmol\/litre (normal 2.10\u20132.60) with a normal serum phosphate level.<\/jats:p>\n                  <jats:p>Treatment with normal saline, frusemide and pamidronate (three daily doses of 30 mg each) reduced the serum calcium to 2.94 mmol\/litre with little symptomatic improvement. He also had tremor and a small goitre when thyrotoxicosis was suspected and confirmed (free thyroxine 57.5, normal 9\u201324 pmol\/litre; triiodothyronine 8.9, normal 0.8\u20132.7 nmol\/litre; and undetectable thyroid- stimulating hormone, normal 0.4\u20134 mu\/litre). Serum parathyroid hormone subsequently was reported as low (&lt;5, normal 12\u201381pg\/ml). He was treated with carbimazole 40 mg daily with remarkable improvement. Subsequently alternative causes of hypercalcaemia were excluded by a normal serum and urine electrophoresis, and bone scan. Serum calcium returned to normal in 3 weeks time. He received radioactive iodine, and became hypothyroid 5 months later. He had done well on follow-up with 75 \u03bcg thyroxine daily and serum calcium remained normal.<\/jats:p>","DOI":"10.12968\/hosp.1999.60.4.1101","type":"journal-article","created":{"date-parts":[[2014,5,23]],"date-time":"2014-05-23T11:32:22Z","timestamp":1400844742000},"page":"303-303","source":"Crossref","is-referenced-by-count":0,"title":["Thyrotoxicosis and abdominal pain: atypical presentation in a middle-aged man"],"prefix":"10.31083","volume":"60","author":[{"given":"A","family":"Bhattacharyya","sequence":"first","affiliation":[{"name":"Diabetes and Endocrinology  in the Department of Medicine (Division of Endocrinology), Royal Albert Edward Infirmary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DJ","family":"Tymms","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Endocrinology), Royal Albert Edward Infirmary, Wigan WN1 2NN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","reference":[{"key":"p_1","doi-asserted-by":"publisher","DOI":"10.1016\/8756-3282(85)90218-2"},{"key":"p_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1986.tb07264.x"},{"key":"p_3","volume-title":"Williams Textbook of Endocrinology","author":"Lersen PR","year":"1992","edition":"8"},{"key":"p_4","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.63.738.269"}],"container-title":["Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.magonlinelibrary.com\/doi\/pdf\/10.12968\/hosp.1999.60.4.1101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:43:57Z","timestamp":1770687837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/60\/4\/10.12968\/hosp.1999.60.4.1101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,4]]},"references-count":4,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1999,4]]}},"alternative-id":["10.12968\/hosp.1999.60.4.1101"],"URL":"https:\/\/doi.org\/10.12968\/hosp.1999.60.4.1101","relation":{},"ISSN":["1462-3935","2053-4299"],"issn-type":[{"value":"1462-3935","type":"print"},{"value":"2053-4299","type":"electronic"}],"subject":[],"published":{"date-parts":[[1999,4]]}}}