Thyrotoxic periodic paralysis: diversity in America

Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study

Thyrotoxic periodic paralysis (TPP) is a rare life-threatening condition most commonly seen in individuals between the ages of 20-40 years. It is most prevalent in Hispanic and Asian populations. Here we present a case report of a young male patient admitted to our facility with an acute onset of paralysis. He was found to have new-onset hyperthyroidism and severe hypokalemia. TPP was exacerbated by the intake of a high-carbohydrate meal as well as a steroid injection within 24 hours of symptom onset.

Case report: Hyperthyroid hypokalemic periodic paralysis

Introduction and importance

HHPP is a rare type of hypokalemic PP that can occur when there is hyperthyroidism.Thyrotoxic periodic paralysis is due to increased influx of potassium into skeletal muscle cells which leads to profound hypokalemia and paralysis. Insulin and Epinephrine are also responsible for stimulating the Na–K-ATPase pumps which are over expressed during hyperthyroid state. Laboratory hypokalemia in the background of hyperthyroidism with sudden symmetric paralysis point toward the diagnosis.

Case

We present a case of 25 year old male with limb weakness for 3hours following heavy dinner.He felt weakness after waking up in the morning where he could not move his both lower limbs. He also had difficulty moving upper limbs.

Clinical findings and investigations

Examination revealed proximal muscle weakness with power of 2/5, decreased muscle tone, diminished deep tendon reflexes in all four limbs and equivocal plantar reflex bilaterally. Investigation sent were Total Leukocyte count, Hemoglobin, Renal function test, Liver Function test,Thyroid function test, Vitamin B12, Serology, ACTH, Serum calcium, Serum phosphate, Serum magnesium, Urine R/ME and Stool R/ME.

Intervention and outcome

Patient is treated with 10mEq/L/hr infusion of potassium chloride, methimazole and beta-blockers. He is stable and is in regular followup in medicine OPD.

Relevance and impact

Early diagnosis of HHPP is very essential to prevent fatal complications (cardiac and respiratory).

It can be treated by timely potassium supplementation, methimazole and beta-blockers.

Clinicians must be concerned about Hyperkalemia while supplementing Potassium in bed side.

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HHPP is a rare life-threatening complication of hyperthyroidism which is characterized by episodes of acute muscle weakness due to hypokalemia.

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Periodic paralysis (PP) is a muscle disease, characterized by episodes of painless muscle weakness. These episodes can be triggered by strenuous exercise, fasting, or consuming high-carbohydrate foods.

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Treatment cand be done by potassium supplementation until normalized serum potassium level. Patient must be kept in cardiac monitoring and serum potassium monitoring.

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Hyperthyroidism can be treated with methimazole. Patient must be kept under regular follow up in endocrinology department.

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Relapses can be prevented by treatment with radioactive iodine or surgery. Beta-blocking drugs have also been proven to reduce the frequency and severity of episodes.

Low-dose oral propranolol for treatment of thyrotoxic periodic paralysis with hypokalaemia in the emergency department: A case report

WHAT IS KNOWN AND OBJECTIVE

Thyrotoxic periodic paralysis (TPP) with hypokalaemia is a rare acute phenomenon. Reports of the use of high-dose non-selective β-blockers describe symptom resolution, but often administration does not occur promptly enough in the treatment course and patients may experience overcorrection and hyperkalaemia.

CASE DESCRIPTION

A 37-year-old Hispanic male developed TPP. Patient was successfully treated with low-dose oral propranolol and potassium supplementation with no overcorrection.

WHAT IS NEW AND CONCLUSION

Delay in the administration of non-selective β-blockers may lead to overcorrection of potassium with exogenous supplementation. Low-dose propranolol administered in the Emergency Department was successful in preventing overcorrection of potassium.

Thyrotoxic Periodic Paralysis: A Spine Consultation

As a consultant, the orthopaedic spine surgeon is often asked to evaluate patients with acute-onset extremity weakness. In some cases, patient's deficits can be attributed to nonspinal pathology; therefore, it is important to be aware of nonorthopaedic diagnoses when evaluating these patients. We report a case of thyrotoxic periodic paralysis that was initially confused by the consulting service with spinal pathology. A 32-year-old Hispanic man presented to our emergency department with rapid onset of lower extremity weakness. The consulting team ordered CT of the cervical and lumbar spine, as well as MRI of the lumbar spine which was aborted due to the patient's worsening tachycardia and chest pain. The spine service was subsequently consulted to evaluate the patient. Review of the metabolic panel revealed a low potassium, and additional testing led to the eventual diagnosis of thyrotoxic periodic paralysis. After correction of the patient's potassium, his weakness rapidly resolved, and no additional spinal workup was pursued. We describe this patient's presentation and outline the differential diagnosis for acute, nontraumatic extremity weakness, including both orthopaedic and other medical causes, that the spine surgeon should be aware of when evaluating patients with extremity weakness.

A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

Patient: Male, 36

Final Diagnosis: Epidural steroid induced thyrotoxic periodic paralysis

Symptoms: Paralysis

Medication: —

Clinical Procedure: Epidural steroid injection

Specialty: Endorinology and Metabolic

Thyrotoxic Periodic Paralysis as a Presentation of Thyrotoxicosis: A Case Report and review of the literature

Thyrotoxic periodic paralysis (TPP) is a rare condition related to thyrotoxicosis seen predominantly in men of Asian origin. Here I present a case of a 34-year-old Chinese man who presented with sudden onset weakness of his upper and lower extremities that resolved spontaneously. His investigations revealed elevated free thyroxin (FT4), free triiodothyronine (FT3), suppressed thyroid-stimulating hormone (TSH) and hypokalemia, and he was diagnosed with thyrotoxic periodic paralysis. It is important to consider the diagnosis of TTP in patients presenting with acute onset of weakness. This report reviews the literature looking at pathophysiology, clinical features, and treatment for this rare complication of hyperthyroidism.

Paralysis that easily reverses: a case of thyrotoxic periodic paralysis

Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis. He was treated with potassium repletion, atenolol and methimazole with complete reversal of his paralysis within the next day. Unfortunately, he failed to keep the follow-up appointment after discharge, ran out of his methimazole and landed up in the ED again.

A Case of Nonfatal Ventricular Arrhythmia Due to Thyrotoxic Periodic Paralysis in a Saudi Patient as an Initial Presentation of Graves' Disease

Thyrotoxic periodic paralysis (TPP) is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. It has been commonly reported in non-Asian populations. Four cases were reported in Saudis so far, and one had a life-threatening arrhythmia. We describe an additional case of a 28-year-old apparently healthy Saudi male patient, who presented with acute paraparesis associated with hypokalemia (K: 2.0 mmol/L), complicated by ventricular tachycardia and cardiac arrest. He was successfully resuscitated and his hypokalemia was corrected. A diagnosis of Graves’ disease associated with TPP was made. He was initially treated with carbimazole and β-blockers and then given a definitive therapy with radioactive iodine, which showed a good response. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness. A brief review of TPP and associated arrhythmia is included.