Letter to Indian Journal of Endocrinology and Metabolism
Hypercalcemia is a common metabolic abnormality encountered in clinical practice, with primary hyperparathyroidism and malignancy being the commonest causes.  We present a case of iatrogenic hypercalcemia, which presented with features of posterior encephalopathy. illustrates an uncommon neurotoxic manifestation of hypercalcemia.
A 63-year-old woman, with Grave’s disease, complicated active thyroid eye disease,underwent a total thyroidectomy 5 months after diagnosis. This operation was complicated by severe hypocalcemia (calcium 0.9 mmol/l) and hypoparathyroidism (parathyroid hormone or PTH < 0.3 pmol/l). It was thought to be secondary to ischemic injury to parathyroid glands as they had been visualized and left intact intraoperatively. Stability was attained on oral calcium and high dose of alfacalcidol.
Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein. Embolism occurs when the thrombus dislodges from its site of origin and travels in the blood.
VTE is an important and preventable cause of morbitity and mortality, with almost a third of survivors experiencing long term effects. To improve survival and prevent complications, the occurence of VTE needs to be reduced.
Current advice: NICE guidance on reducing the risk of VTE in patients admitted to hospital, highlights the need for new research to develop and validate risk prediction models for use by primary care research databases.
Although there are currently no validated algorithms to predict risk for VTE designed for use in primary care, computerised clinical decision support could improve appropriate use of thromboprophylaxis in a hospital setting.
Extended VTE prophylaxis is a research recommendation in the current NICE guidance and features in the VTE NICE Quality Standard.
NICE has guidance in development on the management of venous thromboembolic diseases and the role of thrombophilia testing.
See New Evidence