Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

Kalita, Jayantee; Goyal, Gourav; Bhoi, SK; Chandra, Satish

doi:10.4103/0972-2327.99708

Cited by 17 publications

(12 citation statements)

References 15 publications

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“…Although TPP is commonly seen in patients with GD with overt hyperthyroidism, thyrotoxic symptoms may be absent at the time of TPP attack in 10 to 25% of the patients (2-6). Kalita et al (12) showed that two thirds of the patients with TPP had subclinical hyperthyroidism at the time of presentation. Hegde et al (2) described a 32-year-old Asian male who presented with acute-onset weakness and hypokalemia with no previous history of thyroid disorder or any signs and symptoms suggestive of hyperthyroidism.…”

Section: Discussionmentioning

confidence: 99%

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Rajpal

Sood

2019

AACE Clinical Case Reports

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Objective: Thyrotoxic periodic paralysis is a sporadic form of hypokalemic periodic paralysis (HPP) that is most commonly seen in patients with Graves disease (GD) in association with acute thyrotoxicosis. A very few cases of HPP have been reported in patients with GD while the patient was euthyroid.Methods: We describe a case of a 62-year-old Caucasian male with a history of GD, who presented with acute progressive bilateral lower extremity weakness.Results: The patient was found to have severe hypokalemia, with no evidence of diarrhea or increased urinary potassium excretion. He was diagnosed as having HPP. He remained clinically and biochemically euthyroid during the admission. There was no history of high-carbohydrate meal intake, intense exercise, recent steroid exposure, or unusual stress. His symptoms improved gradually over the next 3 to 4 days with potassium supplementation. Nine months later, he progressed to overt hyperthyroidism and was treated with 25 mCi of iodine-131 and following that he has been on levothyroxine replacement for post-ablative hypothyroidism. Other unusual features in this patient were hypocalcemia, hypomagnesemia, and vitamin D deficiency during the acute presentation. Serum calcium and magnesium normalized 2 days after admission, while serum vitamin D continued to be low. He was later diagnosed to have celiac disease.Conclusion: Our case adds a rare presentation of HPP in a euthyroid patient with a known history of GD with associated celiac disease, hypomagnesemia, and hypocalcemia to the literature. (AACE Clinical Case Rep. 2019;5:e73-e76) Abbreviations: FT3 = free triiodothyronine; FT4 = free thyroxine; HPP = hypokalemic periodic paralysis; MMI = methimazole; TPP = thyrotoxic periodic paralysis; TSH = thyroidstimulating hormone; TSI = thyroid-stimulating immunoglobulin e74 Thyrotoxic Periodic Paralysis, AACE Clinical Case Rep. 2019;5(No. 1)

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Section: Discussionmentioning

confidence: 99%

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Rajpal

Sood

2019

AACE Clinical Case Reports

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“…THPP is a rare manifestation of hyperthyroidism characterised by episodic proximal muscle weakness which increases and decreases 1. It most frequently affects Asian males with hyperthyroidism in the second and third decades of their lives.…”

Section: Discussionmentioning

confidence: 99%

Pituitary macroadenoma: a rare cause of thyrotoxic hypokalaemic periodic paralysis

et al. 2013

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Thyrotoxic hypokalaemic periodic palsy (THPP) is a well-recognised but under-diagnosed complication of hyperthyroidism and is commonly seen in Asian males. Patients usually present fully conscious with acute onset of severe motor weakness. Baseline investigation reveals severe hypokalaemia due to Na(+)/K(+) ATPase overactivity causing a massive influx of intracellular potassium ions. The most common cause of THPP identified in the medical literature is Graves' disease. We report an interesting and unusual case of THPP due to previously undiagnosed hyperthyroidism secondary to a pituitary macroadenoma. The patient was consequently found to have a tumour secreting gonadotropin and thyrotropin.

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“…1 Only few cases are reported in the literature that showed respiratory paralysis due to hypokalemia in distal RTA. Distal RTA is of two types: inherited or acquired.…”

Section: Discussionmentioning

confidence: 99%

Cause of respiratory paralysis: kidney, not the lung

et al. 2015

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Hypokalemia is a common electrolyte abnormality and if neglected, it may be fatal. This type of electrolyte abnormality is seen in distal renal tubular acidosis (RTA). Respiratory paralysis in distal RTA due to hyokalemia is a rare clinical entity described in the literature. Here we discuss one such case: a 25-year-old female presented with complaints of acute onset symmetrical weakness of bilateral lower limbs that rapidly progressed to involve trunk, upper limb and neck. Later on, she developed respiratory paralysis and was put on mechanical ventilation. Diagnosis of distal RTA with hypokalemia was made and managed successfully.

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Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

Cited by 17 publications

References 15 publications

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease

Pituitary macroadenoma: a rare cause of thyrotoxic hypokalaemic periodic paralysis

Cause of respiratory paralysis: kidney, not the lung

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