Pseudo-infarction electrocardiographic changes associated with hypokalemia and hypocalcemia is rare. A 76-year-old lady with previous total thyroidectomy presented with unspecific symptoms. Electrocardiogram demonstrated ST-elevation. She was found to have hypokalemia and hypocalcemia associated with delayed onset hypoparathyroidism. This may suggest possible etiologies like coronary vasospasm and catecholamine-associated myocardial injury.