Thyrotoxic periodic paralysis is rare complication of hyperthyroidism characterized by the sudden onset of hypokalemia and muscle paralysis. It is typically present in young Asian males. There are very few literatures regarding the occurrence of thyrotoxic hypokalemic periodic paralysis in Nepal. We reported a case of a 35-year-old male presented with the chief complaints of weakness of all four limbs of 1 day duration. He was diagnosed as a case of hyperthyroidism in the past, received treatment for 6 months and left medications on his own 6 months ago. Evaluation during admission revealed severe hypokalemia with serum potassium level 1.3mEq/l and high serum Triiodothyronine (>20.00µg/L) and low serum Thyroid Stimulating Hormone (<0.01µg/L). Potassium supplements resolved muscle weakness and the patient was restarted with anti-thyroid drugs. Hence, hypokalemic paralysis is a reversible cause of paralysis and high index of suspicion as well as timely interventions are required to prevent potential harm.

Background: To evaluate the difference in the level of TSH in diabetic and non diabetic patients at the time of the diagnosis of hypothyroidism. Methods: 100 diagnosed cases of hypothyroidism, 50 with diabetes and 50 without diabetes were studied. The level of TSH at the time of diagnosis and other information were obtained from the medical records. Results: The mean TSH in patients with the history of diabetes at the diagnosis of hypothyroidism was 19.9616±26.990 and in those without the history of the diabetes was 10.4797±6.503 (p value 0.018). The females with diabetes had higher level of TSH level at the time of diagnosis of hypothyroidism than females without diabetes (p value 0.045). There was no statistically significant difference in the level of TSH in males with and without diabetes at the time of diagnosis of hypothyroidism. Conclusion: Patients with diabetes mellitus had higher level of TSH at the time of diagnosis of hypothyroidism in comparison to those without diabetes. Early identification of the raised TSH levels in diabetic patients and timely intervention will help to reduce the chances of adverse cardiovascular outcomes and diabetic kidney disease in this group of patients.

Introduction: Diabetes mellitus (DM) results from relative deficiency or reduced effectiveness of endogenous insulin leading to both micro-vascular and macro-vascular complications. Treatment goal is intensive therapy as early as possible in patients with both type-1 and type-2 diabetes to bring the HbA1c to less than 7%. Occurrence of hypoglycemia in a diabetic patient is a common side effect of treatment. This study was aimed to find the causes of Hypoglycemia in diabetes patients. Methods: It was hospital based cross-sectional observational study on admitted diabetes patients with other co-morbid conditions who were on either oral hypoglycemic agents (OHA) or Insulin. Cause of hypoglycemia was elicited by history taking and analysis. Results: Out of 36 diabetics included in this study, seven had severe hypoglycemia, 22 had moderate to mild hypoglycemia. Most of them had various comorbidities. The causes of hypoglycemic episodes were varied. Conclusion:Hypoglycemia can occur despite cautious treatment protocol especially in diabetics with organ dysfunction, which can be prevented by alert and well-coordinated medical team.