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.