Coexisting hyperthyroidism and primary hyperparathyroidism with vitamin D-deficient osteomalacia in a Vietnamese immigrant.

Objective: To present the first report of concurrent hyperthyroidism, primary hyperparathyroidism (PHP), and vitamin D-deficient osteomalacia. Methods: We describe the complicated clinical course in a 65-year-old Vietnamese immigrant, and underlying factors potentially contributing to her condition are discussed. Results: Our patient, who had hyperthyroidism and hypercalcemia, was found to have an inappropriately high level of intact parathyroid hormone (PTH) because of a parathyroid adenoma, detected on a parathyroid scan. With propranolol treatment, however, improvement was noted in both laboratory data--intact PTH, ionized calcium, serum total calcium, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], and urinary cyclic adenosine monophosphate--and findings on ultrasonography and nuclear parathyroid scanning. Later, the adenoma was removed surgically. The improvement of PHP after administration of a b-adrenergic blocker suggested that the parathyroid adenoma in this patient was not completely autonomous. The pat...