OSTEOMALACIA SECONDARY TO CELIAC-DISEASE, PRIMARY HYPERPARATHYROIDISM, AND GRAVES-DISEASE

Primary hyperparathyroidism is seldom associated with other autoimmune disorders, The presence of normocalcemia in primary hyperparathyroidi sm should. prompt the physician to look for vitamin D deficiency, This observation concerns a 34-year-old vegetarian woman with combined pri mary-hyperparathyroidism, Graves' disease, and celiac disease. The pat ient presented with severe bone deformities; she was unable to walls, and had severe muscular weakness and weight loss, Biochemical findings revealed severe hyperparathyroidism with normocalcemia, hypophosphate mia, very low urinary calcium, and low 25-hydroxy vitamin D level. Thy roid tests showed hyperthyroidism with positive thyroid receptor antib odies, confirming the presence of Graves' disease, Positive antigliadi n and antireticulin antibodies and complete villous atrophy on duodena l biopsy established the presence of celiac disease, The patient under went a near-total thyroidectomy, with the removal of a parathyroid ade noma, To our knowledge, this observation is the first finding of an as sociation between celiac disease, Graves' disease, and primary hyperpa rathyroidism, It emphasizes the need to rule out intestinal malabsorpt ion in the case of nomocalcemic hyperparathyroidism.