Hypokalaemic Periodic Paralysis in a Patient with Subclinical Hyperthyroidism: A Rare Case

Hegde, Swati; Shaikh, Mohammed Aslam; Gummadi, Thejaswi

doi:10.7860/jcdr/2016/15489.7131

Cited by 6 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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. He was subsequently diagnosed with GD with subclinical hyperthyroidism (2). Our case had an unusual presentation in that although the patient had a known history of GD, he was euthyroid at the time of the acute presentation of TPP.…”

Section: Discussionmentioning

confidence: 75%

“…These episodes usually occur in the morning or evening hours and are precipitated by strenuous exercise, high-carbohydrate meals, emotional stress, or drugs such as insulin, steroids, or diuretics. Paralysis may last for a few hours to a few days (2). Thus, at present the literature indicates that a combination of genetic predisposition, thyrotoxicosis, and environmental factors causes TPP.…”

Section: Discussionmentioning

confidence: 99%

“…Thyrotoxic periodic paralysis (TPP) is a sporadic form of HPP that is seen in patients with thyrotoxicosis, most commonly in Graves disease (GD). TPP can also occur with subclinical thyrotoxicosis (2). Very few cases of HPP have been reported in patients with GD while being euthyroid (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Rajpal

Sood

2019

AACE Clinical Case Reports

View full text Add to dashboard Cite

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)

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rajpal

Sood

2019

AACE Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…It is important to mention that the total potassium levels inside the body usually remain the same. There is usually no excessive gastrointestinal or urinary loss of potassium [ 6 ]. The severity of the disease is not found to be correlated with the degree of hyperthyroidism, even though the muscle paralysis is known to be resolved once the euthyroid state is achieved.…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Muscle Paralysis as a Rare Cause of Reversible Muscle Weakness: A Case Report

Iqbal

Zia

Niazi

et al. 2020

Cureus

View full text Add to dashboard Cite

Thyrotoxic periodic paralysis is a clinical condition characterized by muscle weakness in patients with underlying hyperthyroidism. It is usually more commonly seen in patients of Asian origin and has a predisposition for the male population (unlike other thyroid disorders which commonly affect the female population). Findings are more overt in patients who have subclinical hyperthyroidism and there is a risk of them remaining untreated. The symptoms can range from mild muscle weakness to total paralysis. The muscles affected predominantly are the proximal and lower extremities group of muscles. Thyrotoxic muscle paralysis can be precipitated by hyperinsulinemic states such as after heavy meals, physical exertion, obesity, stress, and certain medications like high-dose steroids, antiretrovirals, and interferon therapy. The acute intervention usually revolves around the replenishment of patient's potassium stores followed by maintenance therapy with anti-thyroid medications. We present a case of a Chinese adolescent who presented to us with lower muscle weakness and underlying subclinical hyperthyroidism. It's important for clinicians to be familiar with this disease entity and include it in their differentials whenever a patient with muscle weakness presents. The treatment is simple and can result in rapid improvement of symptoms and should be initiated quickly.

show abstract

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

2018

View full text Add to dashboard Cite

Patient: Male, 36Final Diagnosis: Epidural steroid induced thyrotoxic periodic paralysisSymptoms: ParalysisMedication: —Clinical Procedure: Epidural steroid injectionSpecialty: Endorinology and MetabolicObjective:Rare diseaseBackground:Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases.Case Report:A 36-year-old Asian man presented to the emergency department with sudden onset of paralysis of all his limbs following epidural steroid injection for traumatic low back pain. At presentation, he was found to have severe hypokalemia of 1.8 mEq/L. Further investigations led to the diagnosis of hyperthyroidism and Graves’ disease. In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected. He had a rapid recovery and an early discharge from hospital.Conclusions:Although several factors can lead to paralysis after an epidural steroid injection, TPP should be considered in the differential diagnosis, especially in individuals who have predisposing factors of ethnicity and gender. If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed. In the management of patients with TPP, care should be taken when correcting potassium levels.

show abstract

Hypokalaemic Periodic Paralysis in a Patient with Subclinical Hyperthyroidism: A Rare Case

Cited by 6 publications

References 11 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

Thyrotoxic Muscle Paralysis as a Rare Cause of Reversible Muscle Weakness: A Case Report

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

Contact Info

Product

Resources

About