Periodic Paralysis as a New Phenotype of Resistance to Thyroid Hormone Syndrome in a Chinese Male Adult

Ma, Shengming; Hu, Mingming; Yang, Hongbo; Lian, Xiaolan; Jiang, Yanqiu

doi:10.1210/jc.2015-3564

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…HP with hypothyroidism has been reported on 15 occasions previously (16 adults, 2 children). [ 4 5 6 7 8 9 10 11 12 ] Eleven (11/18) patients with HP had hypokalemic periodic paralysis (HPP). One patient had resistance to thyroid hormone and was already on L-thyroxine without improvement in his episodic paralysis.…”

Section: Discussionmentioning

confidence: 99%

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Sporadic hypothyroidism-related hypokalemic paralysis: Diagnosis in a resource-poor setting

Kadeeja

Senthilnathan

Viswanathan

et al. 2017

J Family Med Prim Care

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Hypothyroidism and distal renal tubular acidosis causing hypokalemic paralysis (HP) have been described only in four female patients. HP as the initial manifestation of uncomplicated diabetes has been reported only in three young males. We report two middle-aged patients presenting with gradual-onset areflexic quadriparesis and neck flop, associated with urinary potassium losses, and recovering over 3 days. The male patient with alcohol abuse had urine pH >5.5 and hyperchloremic metabolic acidosis due to renal tubular acidosis and hypothyroidism. The second, a hypertensive female, had metabolic alkalosis, hypomagnesemia, and diabetes mellitus diagnosed at admission. Both these patients improved with intravenous and oral potassium supplementation.

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Section: Discussionmentioning

confidence: 99%

“…One patient had resistance to thyroid hormone and was already on L-thyroxine without improvement in his episodic paralysis. [ 9 ] Both our patients came with their first episodes of weakness. Five reports had females with both DRTA and hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

Sporadic hypothyroidism-related hypokalemic paralysis: Diagnosis in a resource-poor setting

Kadeeja

Senthilnathan

Viswanathan

et al. 2017

J Family Med Prim Care

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“…GD is still the most common cause of TPP; however, reported TPP cases were diverse [10] . A recent case report of Chinese patient with resistance to β-subunit of thyroid hormone (RTH) presented with TPP added to the list of cause of TPP and challenged the concept of RTH manifestations [18] . In GD patients with TPP, many reports showed that TPP was a sole initial presentation and other thyrotoxic symptoms and signs could be overlooked [13] , [19] .…”

Section: Discussionmentioning

confidence: 99%

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis

Karndumri

Thewjitcharoen

Chatchomchuan

et al. 2020

Journal of Clinical & Translational Endocrinology

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Background Thyrotoxic periodic paralysis (TPP) is a unique manifestation of Graves’ disease. While it is uncommon in Asian, it is extremely rare in Caucasian patients (0.1–0.2%). Previous studies suggested that TPP indicate more severity of Graves’ disease and definitive treatments should be used to prevent relapses. Aim To describe clinical features and impact of first-line treatment on long-term outcomes of TPP patients. Method A retrospective cohort study over 35 years (1985–2019) of TPP from Graves’ disease patients was conducted. All cases were analyzed and their clinical courses were compared between those who received anti-thyroid drugs (ATD) versus radioactive iodine (RAI) as a primary treatment. None of them underwent surgery. Results A total of 2964 hyperthyroid Graves’ disease patients were treated and followed-up at least 3 months over the study period. TPP was identified in 63 cases (2.1%) of all patients. There were 60 males and only 3 females with age at presentation of 35.0 ± 8.2 years. TPP was the first presentation of hyperthyroid Graves’ disease in 82.5% of them. During the acute attack of TPP, all patients presented with bilateral lower limb flaccid weaknesses with median serum potassium of 2.1 mmol/L. No fatal TPP cases were found. RAI was selected as primary treatment in 27 patients (42.9%). Nearly all RAI-treated patients rendered hypothyroidism with the median RAI dose at 15 mCi. No patients who were in remission after RAI treatment developed recurrent attack of TPP. In the remaining 36 ATD-treated patients with mean follow-up time at 9.1 years, relapse was found in 10 patients (27.8%) after the drug discontinuation and 6 patients suffered recurrent TPP. Only 8 ATD-treated TPP patients (22.2%) went into remission. Conclusions TPP is a rare complication of hyperthyroid Graves’ disease. Definitive treatment with RAI or thyroidectomy should be employed to prevent relapse and further attacks of TPP.

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“…Studistudi elektrofisiologi saat ini menyebutkan bahwa defek yang fundamental pada hipokalemia periodik paralisis melibatkan peningkatan permeabilitas membran natrium otot. 13,14 Tampilan klinis yang paling menonjol dari hipokalemia adalah pada sistem neuromuskular, walaupun sistem lainya seperti kardiovaskular dan gastrointestinal dapat juga terkena. Beberapa pasien mengeluhkan kelemahan otot, terutama pada ekstremitas bawah, dan kelemahan umum otot rangka merupakan keadaan umum pada kekurangan kalium yang berat.…”

Section: Diskusiunclassified

“…Kelemahan biasanya terjadi pada otot kaki dan tangan, tetapi terkadang dapat mengenai otot mata, otot pernafasan, dan otot untuk menelan, yang mana kedua keadaan terakhir ini dapat berakibat fatal. 13,15 Pada saat serangan paralisis dan disertai hipokalemia yang nyata, pemberian suplementasi kalium klorida (KCl) dapat dilakukan untuk mencegah komplikasi berat kardiopulmonal. Suplementasi KCl dapat diberikan melalui jalur intravena, oral, maupun keduanya.…”

Section: Diskusiunclassified

Tantangan Diagnosis dan Tata Laksana Kecurigaan Hepatitis Autoimun pada Wanita 34 tahun dengan Periodik Paralisis dan Penyakit Graves

Larasati¹,

Wahono²

2022

JPDI

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Hipokalemia periodik paralisis merupakan suatu kelemahan otot yang dapat disebabkan oleh kondisi hipertiroid akibat penyakit Graves. Prevalensi penderita hipokalemia periodik paralisis dengan gejala tirotoksikosis mencapai 10%. Penyakit Graves merupakan suatu kelainan sistem imun yang dapat menyebabkan disfungsi organ lainnya seperti pada kondisi hepatitis autoimun. Penegakan diagnosis hepatitis auotimun saat ini masih menjadi tantangan bagi klinisi karena ada keterbatasan fasilitas pelayanan pemeriksaan penunjang seperti smooth muscle antibodies (SMA), antimitochondrial antibodies (AMA), anti-liver/kidney microsomal antibodies type 1 (anti LKM-1), yang seringkali masih sulit didapatkan. Artikel ini membahas mengenai kasus wanita 34 tahun dengan kelemahan anggota gerak tubuh sejak 3 bulan dan memberat, penurunan berat badan sebanyak 4 kg dalam waktu 1 bulan, sering merasa lapar, gelisah dan sulit tidur karena tidak tahan terhadap udara panas dan berdebar-debar. Pada pasien didapatkan urin berwana keruh sejak 10 hari terakhir. Hasil pemeriksaan laboratorium menunjukkan peningkatan kadar alanin transminase (ALT) 256 U/I dan aspartat aminotransferase (AST) 142 U/I disertai peningkatan kadar bilirubin total 12,09 mg/dl, bilirubin direct 10,5 mg/dl. Penanda infeksi virus hepatitis HbsAg non-reaktif dan anti-HCV negatif, kadar kalium 2,29 mmol/L, dan antinuclear antibody test 1,3 IU/ml, thyroid stimulating hormone (TSH) <0,01 uIU/ml, dan FT4 5,46 mg/dl. Hasil USG abdomen menunjukkan chronic liver disease. Histopatologi dari jaringan liver menunjukkan kronik hepatitis dengan infiltrasi inflamatori. Pasien diterapi dengan pemberian tiamazol, suplemen potasium, propranolol, dan prednison. Hasilnya, keluhan dan fungsi hati membaik.

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Periodic Paralysis as a New Phenotype of Resistance to Thyroid Hormone Syndrome in a Chinese Male Adult

Abstract: This is the first report of periodic paralysis as a new phenotype of RTH syndrome.

Cited by 4 publications

References 11 publications

Sporadic hypothyroidism-related hypokalemic paralysis: Diagnosis in a resource-poor setting

Sporadic hypothyroidism-related hypokalemic paralysis: Diagnosis in a resource-poor setting

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis

Tantangan Diagnosis dan Tata Laksana Kecurigaan Hepatitis Autoimun pada Wanita 34 tahun dengan Periodik Paralisis dan Penyakit Graves

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