Conclusion
The finding of ST-elevation pattern in ECG can be non-specific and has been reported to be associated with electrolyte imbalance, pericarditis and coronary vasospasm1. Taking into account ischemic time as well as circulatory failure, the consideration of other differential diagnoses in clinical practice might be difficult before laboratory results are made available. The present case reinforces the importance to explore the possibility of reversible electrolyte-induced ECG changes even if an ischemic cause is suspected. We propose further research in coronary investigations to demonstrate the underlying mechanism. Late-onset hypoparathyroidism has been shown to give rise to hypocalcemia several years after thyroidectomy and can be missed due to the non-specific nature of hypocalcemia symptoms as well as the lack of consistency in regular follow up. This is an important phenomenon to consider when assessing patients with history of previous neck surgery even if they appear to be well controlled in symptoms or given history of taking thyroxine diligently. While this case illustrates the rarity of the combination of etiologies leading to the patient’s presentation, it reminds practitioners to remain comprehensive when assessing patients in acute setting, especially the geriatric patient population.