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.