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Idham M, Prajitno JH. Management of hypokalemia in patients with thyrotoxicosis periodic paralysis in Soetomo general hospital: A case report. Ann Med Surg (Lond) 2022; 84:104925. [PMID: 36582870 PMCID: PMC9793236 DOI: 10.1016/j.amsu.2022.104925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction The prevalence of Graves' disease varies widely between 21 and 80% of all cases of hyperthyroidism. Research conducted in 2018 at the Dr. Soetomo Regional General Hospital Surabaya found Graves' disease in as many as 66.7% of all cases of hyperthyroidism. Thyrotoxicosis Periodic Paralysis (TPP) is a disorder characterized by reversible muscle weakness and paralysis, accompanied by hypokalemia, which usually accompanies hyperthyroidism, mostly caused by Graves' disease. Management of severe hypokalemia in TPP is challenging. Case illustration male, 29 years patient complained that both lower legs felt weak in the last 6 hours before coming to the hospital emergency department. The patient was diagnosed with hyperthyroidism in 2018. A fine tremor was found, and the patient was admitted to the hospital for 4 days and routinely controlled at the endocrine polyclinic. Clinical discussion The underlying disease or causative etiology of thyrotoxicosis must be determined before treatment is conducted. The main concern when performing potassium replacement therapy is the occurrence of rebound hyperkalemia because this hypokalemia condition is caused not by total potassium depletion. Conclusion The principles of management for thyrotoxicosis periodic paralysis are proper diagnosis, exclusion of other causes of paralysis, and other causes of hypokalemia, slow and gradual correction of hypokalemia, and close and careful clinical monitoring, ECG, and laboratory.
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Affiliation(s)
- Muhammad Idham
- Corresponding author. Internal Medicine Departement, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Jl. Mayjend Prof. Dr. Moestopo No. 6-8, Surabaya, 60285, Indonesia.
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Orjuela Quiroga JE, Celly Abarca L, Gómez Pérez BH, Ocampo Posada M, Garcés Villabón L. Parálisis periódica hipocalémica tirotóxica. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introducción: las parálisis periódicas son desórdenes neuromusculares dentro de los cuales se encuentra la hipocalémica, que puede ser primaria o secundaria. De especial interés es la hipocalémica tirotóxica por su baja sospecha en el hemisferio occidental. Presentación: paciente que acudió al servicio de urgencias de una clínica en Cali, Colombia aquejando la triada clásica de esta entidad y quien tras recibir tratamiento óptimo resolvió por completo su cuadro clínico. Discusión: se hace énfasis en los hallazgos en la literatura universal y su similitud con el cuadro del paciente. Conclusión: se destaca la importancia de estudios epidemiológicos que analizan la prevalencia e incidencia de esta enfermedad en nuestro país y la importancia de concebir esta entidad como sospecha clínica dado que se trata de una emergencia médica.
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Dosu A, Gupta M, Walsh O, Makan J. Thyrotoxic Periodic Paralysis: Case Presentation With Tetraparesis and Cardiac Dysrhythmia. Cureus 2022; 14:e29759. [DOI: 10.7759/cureus.29759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
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Qin YZ, Liu YM, Wang Y, You C, Li LN, Zhou XY, Lv WM, Hong SH, Xiao LX. Novel compound heterozygous mutation of SLC12A3 in Gitelman syndrome co-existent with hyperthyroidism: A case report and literature review. World J Clin Cases 2022; 10:7483-7494. [PMID: 36158002 PMCID: PMC9353888 DOI: 10.12998/wjcc.v10.i21.7483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gitelman syndrome (GS) is a rare inherited autosomal recessive tubulopathy, characterized clinically by hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis, and is caused by an inactivating mutation in SLC12A3. GS is prone to misdiagnosis when occurring simultaneously with hyperthyroidism. It is important to consider the possibility of other diseases when hyperthyroidism is combined with hypokalemia, which is difficult to correct.
CASE SUMMARY A female patient with hyperthyroidism complicated with limb weakness was diagnosed with thyrotoxic hypokalemic periodic paralysis for 4 mo. However, the patient’s serum potassium level remained low despite sufficient potassium replacement and remission of hyperthyroidism. GS was confirmed by whole exome and Sanger sequencing. Gene sequencing revealed compound heterozygous mutations of c.488C>T (p.Thr163Met), c.2612G>A (p.Arg871His), and c.1171_1178dupGCCACCAT (p.Ile393fs) in SLC12A3. Protein molecular modeling was performed to predict the effects of the identified missense mutations. All three mutations cause changes in protein structure and may result in abnormal protein function. All previously reported cases of GS coexisting with autoimmune thyroid disease are reviewed.
CONCLUSION We have identified a novel compound heterozygous mutation in SLC12A3. The present study provides new genetic evidence for GS.
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Affiliation(s)
- Yong-Zhang Qin
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Yan-Ming Liu
- Department of Endocrinology, The First People’s Hospital of Nankang District, Ganzhou 341400, Jiangxi Province, China
| | - Yang Wang
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Cong You
- Department of Dermatology and Venereology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Long-Nian Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xue-Yan Zhou
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Wei-Min Lv
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Shi-Hua Hong
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Li-Xia Xiao
- Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
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Abstract
When asked to assess patients in an intensive care unit (ICU) who have respiratory muscle weakness, oropharyngeal weakness and a vulnerable airway, our immediate thought may be of Guillain-Barré syndrome or myasthenia gravis, but there are many other possible causes. For example, previously unrecognised chronic neurological conditions may decompensate and require ICU admission. Clinicians can use various clinical clues to help recognise them and need to understand how patterns of weakness reflect differing causes of reduced consciousness on ICU. Additionally, patients admitted to ICU for any reason may develop weakness during their stay, the most likely cause being ICU-acquired weakness. Assessing patients in ICU is challenging, hampered by physical barriers (machines, tubes), medication barriers (sedatives) and cognitive barriers (delirium, difficulty communicating). Nonetheless, we need to reach a clinical diagnosis, organise appropriate tests and communicate clearly with both patients and ICU colleagues.
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Hung SY, Liu WJ, Wu PC, Yang MC, Wu YK, Lan CC. Noninvasive ventilator prevents intubation in thyrotoxic hypokalemic periodic paralysis-associated respiratory failure: A case report and literature review. Tzu Chi Med J 2021; 33:91-95. [PMID: 33505885 PMCID: PMC7821826 DOI: 10.4103/tcmj.tcmj_248_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/06/2019] [Accepted: 12/21/2020] [Indexed: 11/05/2022] Open
Abstract
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, often presents with limb muscle paralysis, hypokalemia with elevated-free T3, T4, and low thyroid-stimulating hormone (TSH). We herein reported an unusual presentation of TPP with acute hypercapnic respiratory failure. A 28-year-old female had complaints of nausea and vomiting. Laboratory investigations showed a serum potassium level of 1.2 mEq/L. Thyroid function test revealed the TSH level of 0.021 μlU/mL and free T4 at 2.01 ng/dL. She suddenly suffered from dyspnea and drowsiness. Acute hypercapnic respiratory failure with CO2 retention was found. Noninvasive ventilation was used. Rapid correction of hypokalemia and administration of propylthiouracil, propranolol, and 5% Lugol's solution were performed. After the normalization of potassium levels, the patient's respiratory pattern stabilized and noninvasive ventilator (NIV) use was discontinued. Respiratory failure is an unusual but lethal complication of TPP. Rapid correction of hypokalemia and temporarily NIV can successfully avoid endotracheal intubation for respiratory failure.
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Affiliation(s)
- Shu-Ya Hung
- Division of Respiratory Therapy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Wen-Jing Liu
- Division of Respiratory Therapy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Pei-Chan Wu
- Division of Respiratory Therapy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Oba T, Kobayashi S, Nakamura Y, Nagao M, Nozu K, Fukuda I, Iijima K, Sugihara H. A Case of Gitelman Syndrome that Was Difficult to Distinguish from Hypokalemic Periodic Paralysis Caused by Graves' Disease. J NIPPON MED SCH 2019; 86:301-306. [PMID: 31105122 DOI: 10.1272/jnms.jnms.2019_86-505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A 21-year-old man presented with hyperthyroidism and hypokalemia and was treated for thyrotoxic hypokalemic periodic paralysis caused by Graves' disease. Thyroid function soon normalized but hypokalemia persisted. Laboratory data revealed hyperreninemic hyperaldosteronism and metabolic alkalosis consistent with Gitelman Syndrome. The patient was found to have a previously unreported compound heterozygous mutation of T180K and L858H in the SLC12A3 gene, and Gitelman Syndrome was diagnosed. He was started on eplerenone to control serum potassium level. Alternative diagnoses should be considered when electrolyte imbalances persist after disease resolution.
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Affiliation(s)
- Takeshi Oba
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
| | - Shunsuke Kobayashi
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
| | - Yuko Nakamura
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
| | - Mototsugu Nagao
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Izumi Fukuda
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Hitoshi Sugihara
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School
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Thyrotoxic periodic paralysis complicated by life-threatening acute hypercapnic respiratory failure in a Chinese male with painless thyroiditis. Am J Emerg Med 2019; 37:379.e1-379.e3. [DOI: 10.1016/j.ajem.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/05/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022] Open
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Correia M, Darocki M, Hirashima ET. Changing Management Guidelines in Thyrotoxic Hypokalemic Periodic Paralysis. J Emerg Med 2018; 55:252-256. [PMID: 29871829 DOI: 10.1016/j.jemermed.2018.04.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/27/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Periodic paralysis is a rare complication of hyperthyroidism. Patients of East Asian descent are most commonly affected. Presentation is characterized by recurrent episodes of painless, abrupt-onset weakness, with laboratory evaluation characterized by profound hypokalemia. Underlying hyperthyroidism may not be clinically evident, but differentiation from the familial variant is critical due to differing treatment pathways. CASE REPORT We describe the presentation of a 22-year-old man with recurrent relapsing-remitting weakness with undiagnosed hyperthyroidism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with acute-onset paralysis with significant hypokalemia, or relapsing-remitting symptoms, hyperthyroidism should be suspected. Obese patients are at an especially increased risk due to underlying insulin resistance, which enhances basal sodium-potassium ATPase function. Hypokalemia is functional in nature. Nonselective β-blockers (such as propranolol) should be considered first line, as they simultaneously decrease ATPase activity, limit insulin secretion, and address the underlying disorder. Administration of > 50 mEq of exogenous potassium places patients at risk of dysrhythmias from rebound hyperkalemia.
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Affiliation(s)
- Matthew Correia
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
| | - Mark Darocki
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
| | - Eva Tovar Hirashima
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
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Inoue K, Saito J, Kondo T, Miki K, Sugisawa C, Tsurutani Y, Hasegawa N, Kowase S, Kakuta Y, Omura M, Nishikawa T. Amiodarone-induced Thyrotoxicosis with Cardiopulmonary Arrest. Intern Med 2018; 57:59-63. [PMID: 29033440 PMCID: PMC5799058 DOI: 10.2169/internalmedicine.9177-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of amiodarone-induced thyrotoxicosis (AIT) with cardiopulmonary arrest (CPA) in a 49-year-old woman. The patient had been treated with amiodarone for non-sustained ventricular tachycardia. Two weeks prior to her admission, she developed thyrotoxicosis and prednisolone (PSL, 30 mg daily) was administered with the continuation of amiodarone. However, she was admitted to our hospital for CPA. We performed total thyroidectomy to control her thyrotoxicosis and the pathological findings were consistent with type 2 AIT. She gradually improved and was discharged on day 84. This case demonstrates the importance of considering immediate total thyroidectomy for patients with uncontrollable AIT.
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Affiliation(s)
- Kosuke Inoue
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Kondo
- Department of Human Pathology, University of Yamanashi Interdisciplinary Graduate School of Medicine and Engineering, Japan
| | - Kaoru Miki
- Departments of Endocrinology and Diabetes, JCHO Tokyo Yamate Medical Center, Japan
| | - Chiho Sugisawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | | | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Japan
| | - Yukio Kakuta
- Department of Pathology, Yokohama Rosai Hospital, Japan
| | - Masao Omura
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
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11
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Bilateral Lower Extremity Paralysis in a Caucasian Male Presenting to the Emergency Department. Case Rep Emerg Med 2018; 2018:5740509. [PMID: 29862090 PMCID: PMC5976972 DOI: 10.1155/2018/5740509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
Abstract
Reported is a case of a 39-year-old Caucasian man who presented to the emergency department with sudden onset bilateral lower extremity paralysis after consuming a large amount of carbohydrates and alcohol. A CT, MRI, and lumbar puncture were performed with negative results; lab results showed hyperthyroidism and hypokalemia. The patient was diagnosed with thyrotoxic periodic paralysis. In a patient presenting with sudden onset paralysis and hypokalemia, the emergency physician should include thyrotoxic periodic paralysis in the differential diagnosis and focus on treating and working up the hypokalemia instead of the paralysis.
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12
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Abstract
Bipolar disorders, and other psychoses, are known to be triggered by a number of agents apart from the reproductive process. In some women, pregnant or recently delivered, psychosis may be due to these alternative triggers. There are substantial numbers of mothers suffering from childbearing psychoses, who have been prescribed bromocriptine or steroids, have had surgical operations or developed thyrotoxicosis. It is best to eliminate these episodes and cases from study samples of puerperal psychosis.
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Shields DL. A case of thyrotoxic periodic paralysis with respiratory failure in an African American woman. Am J Crit Care 2015; 24:264-7. [PMID: 25934725 DOI: 10.4037/ajcc2015910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective β-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease.
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Affiliation(s)
- Denise L Shields
- Denise L. Shields is an acute care nurse practitioner at Robert Wood Johnson University Hospital, Hamilton Township, New Jersey.
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Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne) 2014; 5:102. [PMID: 25071718 PMCID: PMC4076793 DOI: 10.3389/fendo.2014.00102] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/15/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency. DATA SOURCE We searched the electronic MEDLINE database on September 2013. Data Selection and Data Extraction: Reviews, original articles, and case reports on "myxedematous coma," "HC," "thyroid storm," "TS," "massive goiter," "huge goiter," "prevalence," "etiology," "diagnosis," "therapy," and "prognosis" were selected. DATA SYNTHESIS AND CONCLUSION Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques - e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.
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Affiliation(s)
- Giampaolo Papi
- Department of Endocrinology, Catholic University of Rome, Rome, Italy
| | | | - Alfredo Pontecorvi
- Department of Endocrinology, Catholic University of Rome, Rome, Italy
- *Correspondence: Alfredo Pontecorvi, Department of Endocrinology, Catholic University of Rome, Largo A. Gemelli 1, 00168 Rome, Italy e-mail:
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Unilateral Gynecomastia and Hypokalemic Periodic Paralysis as First Manifestations of Graves’ Disease. Am J Med Sci 2013; 345:504-6. [DOI: 10.1097/maj.0b013e31827c9411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Falhammar H, Thorén M, Calissendorff J. Thyrotoxic periodic paralysis: clinical and molecular aspects. Endocrine 2013; 43:274-84. [PMID: 22918841 DOI: 10.1007/s12020-012-9777-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/13/2012] [Indexed: 10/28/2022]
Abstract
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism that most often affects young East Asian males but increasingly also in other ethnic groups. The typical presentation is acute attacks varying from mild weakness to total paralysis starting at night or in the early morning a few hours after a heavy meal, alcohol abuse or strenuous exercise with complete recovery within 72 h. Signs and symptoms of hyperthyroidism may not be obvious. The hallmark is hypokalemia from increased cellular sodium/potassium-ATPase pump activity with transport of potassium from the extracellular to the intracellular space in combination with reduced potassium output. Recently, KCNJ18 gene mutations which alter the function of an inwardly rectifying potassium channel named Kir2.6 have been detected in 0-33 % of cases. Hence, the pathophysiology in TPP includes a genetic predisposition, thyrotoxicosis and environmental influences and the relative impact from each of these factors may vary. The initial treatment, which is potassium supplementation, should be given with caution due to a high risk of hyperkalemia. Propranolol is an alternative first-line therapeutic option based on the assumption that hyperadrenergic activity is involved in the pathogenesis. If thyroid function tests are unobtainable in the acute situation the diagnosis is supported by the findings of hypokalemia, low spot urine potassium excretion, hypophosphatemia with hypophosphaturia, high spot urine calcium/phosphate ratio, and electrocardiographic abnormalities as tachycardia, atrial fibrillation, high QRS voltage, and atrioventricular block. Definitive treatment is cure of the hyperthyroidism. The underlying mechanisms of TPP remain, however, incompletely understood awaiting further studies.
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Affiliation(s)
- Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, D2:04, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Trifanescu RA, Danciulescu Miulescu R, Carsote M, Poiana C. Hypokalemic periodic paralysis as first sign of thyrotoxicosis. J Med Life 2013; 6:72-5. [PMID: 23599824 PMCID: PMC3624652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/14/2013] [Indexed: 12/04/2022] Open
Abstract
Background: periodic paralysis related to hypokalemia is seldom reported in thyrotoxicosis, and it usually occurs in Asian males. Patients and methods: Two Romanian (Caucasian) young patients presented with hypokalemic paralysis. TSH, FT4, TT3 was measured by immunochemiluminescence. Case report 1. Patient O.R, aged 19, presented marked asthenia and lower limbs paralysis, following high carbohydrate meal. He declared 10 kg weight loss on hypocaloric diet and mild sweating. Biochemical data revealed moderate hypokalemia (K+=2.6 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=30 pmol/L, TT3=315 ng/dL). Case report 2. Patient T.A., aged 18, presented 2 episodes of weakness and flaccid paralysis, with hypokalemia, precipitated by effort, without any sign of thyrotoxicosis. Biochemical data revealed severe hypokalemia (K+=1.8 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=24 pmol/L, TT3=190 ng/dL). Treatment with intravenous potassium, thereafter methimazole and propranolol were administered in both cases, with the maintenance of normal kalemia and thyrotoxicosis’ control. Conclusion: these 2 cases of hypokalemic periodic paralysis occurring in young Caucasian teenagers with mild thyrotoxicosis underlined the importance of thyroid screening in patients with symptomatic hypokalemia, even in the absence of symptoms and signs of thyrotoxicosis.
Abbreviations: THPP=Thyrotoxic periodic paralysis, BMI=body mass index, TRAb=TSH receptor antibody, ECG=electrocardiogram.
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Affiliation(s)
- R A Trifanescu
- Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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18
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Chanson P, Richard C. Prise en charge en réanimation du coma myxoedémateux et des formes graves de thyrotoxicose. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Imashuku S, Teramura-Ikeda T, Kudo N, Kaneda S, Tajima T. Concurrence of thyrotoxicosis and Gitelman's syndrome-associated hypokalemia-induced periodic paralysis. Pediatr Rep 2012; 4:e18. [PMID: 22802996 PMCID: PMC3395976 DOI: 10.4081/pr.2012.e18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 12/29/2011] [Indexed: 11/22/2022] Open
Abstract
A 16-year-old Japanese boy with a history of truancy had been treated at a psychiatric clinic. When the patient was referred to us for hypokalemia-associated paralysis, the diagnosis of thyrotoxic hypokalemic periodic paralysis was made, common in Asian men. Subsequently, the patient was found to have persistently high plasma renin and aldos-terone levels. Thus, solute carrier family 12 member 3 gene (SLC12A3) analysis was performed. A novel missense homozygous mutation CTC->CAC at codon 858 (L858H) was found for which the patient was homozygous and his non-consanguineous parents heterozygote. These findings indicated that the patient developed hypokalemia-associated paralysis concurrently with thyrotoxicosis and Gitelman's syndrome. This case underscores the importance of careful examinations of adolescents with complaints of truancy as well as of precise determinations of the causes of hypokalemia-associated paralysis.
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Rezania K, Goldenberg FD, White S. Neuromuscular Disorders and Acute Respiratory Failure: Diagnosis and Management. Neurol Clin 2012; 30:161-85, viii. [DOI: 10.1016/j.ncl.2011.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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