Severe Hypokalemia and Thyrotoxic Paralysis from Painless Thyroiditis Complicated by Life-threatening Polymorphic Ventricular Tachycardia and Rhabdomyolysis

Chang, Kyung Yoon; Lee, Suhyun; Park, Hoon Suk; Ko, Sun-Hee; Ahn, Yu‐Bae; Kim, Hyung Wook

doi:10.2169/internalmedicine.53.2419

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…11 Tall P waves, prominent J waves, ST-segment depression, a prolonged QT interval, premature ventricular contraction, ventricular tachycardia, and torsade de pointes can also be observed in patients with hypokalemia. [12][13][14][15][16] In the present case of severe hypokalemia, the ECG showed typical alterations in T waves, U waves, and a prolonged QU interval. Multiple mechanisms contribute to the dynamic morphology of T waves related to hypokalemia.…”

Section: Discussionsupporting

confidence: 49%

Electrocardiographic manifestations in severe hypokalemia

Wang

Han

2018

J Int Med Res

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Hypokalemia is one of the most common electrolyte disturbances in the clinic and it can increase the risk of life-threatening arrhythmias. Electrocardiographic characteristics associated with hypokalemia include dynamic changes in T-wave morphology, ST-segment depression, and U waves, which are often best seen in the mid-precordial leads (V2–V4). The PR interval can also be prolonged along with an increase in the amplitude of the P wave. We report a case of a patient with hypokalemia (1.31 mmol/L) who showed typical electrocardiographic characteristics of hypokalemia.

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Section: Discussionsupporting

confidence: 49%

Electrocardiographic manifestations in severe hypokalemia

Wang

Han

2018

J Int Med Res

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“…In this case, based on the patient's clinical presentation and associated findings, a diagnosis of TPP due to painless thyroiditis was made. Painless thyroiditis presenting with TPP has been rarely reported [7][8][9][10][11]. A literature review revealed only 8 cases of TPP due to painless thyroiditis including our case ( Table 1).…”

Section: Discussionmentioning

confidence: 84%

Thyrotoxic periodic paralysis complicated by life-threatening acute hypercapnic respiratory failure in a Chinese male with painless thyroiditis

Qian

Dai

Zhu

et al. 2019

The American Journal of Emergency Medicine

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Context: Thyrotoxic periodic paralysis (TPP) is a relatively common complication seen in Asian hyperthyroid patients. However, it is a rare occurrence to find a TPP case comprised of acute hypercapnic respiratory failure in patients with painless thyroiditis. Patient: A 29-year-old Chinese man presented with flaccid paralysis of all four limbs and he was brought to emergency room. Severe hypokalemia was found on admission. Although treatment had been initiated with potassium chloride supplementation, he went on to develop acute hypercapnic respiratory failure likely due to muscle fatigue. The patient was intubated for mechanical ventilatory support. Once his serum potassium levels were normalized, he was able to be weaned off ventilator support. Thyroid function tests showed elevated free thyroxine concentration and low thyroid-stimulating hormone concentration. He underwent a thyroid uptake scan with 131 I which revealed decreased uptake rate of thyroid area. Based on the patient's clinical presentation and associated findings, we diagnosed him with TPP due to painless thyroiditis. We have reviewed TPP cases caused by painless thyroiditis and TPP cases associated with acute hypercapnic respiratory failure. Conclusion: It is important to note that potentially fatal complications such as acute hypercapnic respiratory failure might occur in acute attacks of TPP even in cases of TPP due to painless thyroiditis.

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“…Profound hypokalemia with serum potassium levels of less than 2.5 mEq/L, may cause rhabdomyolysis by reducing blood flow to the muscles in response to exertion [ 21 ]. Hypokalemia is also associated with severe muscle weakness and pain in the setting of thyrotoxic periodic paralysis (TPP) [ 26 ], and in a reported case of TTP, myopathy progressed to the development of rhabdomyolysis [ 27 ]. In our case, the patient had only mild hypokalemia ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis in a Patient with Severe Hypothyroidism

et al. 2017

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Patient: Female, 52Final Diagnosis: Hypothyroidism induced rhabdomyolysisSymptoms: Bilateral leg pain • fatigueMedication: Levothyroxine • Calcitriol • Calcium GluconateClinical Procedure: —Specialty: Endocrinology and MetabolicObjective:Unusual clinical courseBackground:Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients with hypothyroidism who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified.Case Report:We report a case of a 52-year-old Hispanic woman with a history of hypothyroidism, hypertension, and type 2 diabetes mellitus who presented with fatigue, severe generalized weakness, bilateral leg pain, and recurrent falls. She reported poor medication compliance for the preceding month. Initial laboratory testing showed elevated thyroid stimulating hormone (TSH) and creatine kinase (CK) levels, indicating uncontrolled hypothyroidism with associated rhabdomyolysis. Supportive treatment with intravenous fluids and intravenous levothyroxine were initiated and resulted in dramatic clinical improvement.Conclusions:We report a case of rhabdomyolysis, which is a rare but potentially serious complication of hypothyroidism. Screening for hypothyroidism in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment of hypothyroidism is essential to prevent rhabdomyolysis and its consequences.

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Severe Hypokalemia and Thyrotoxic Paralysis from Painless Thyroiditis Complicated by Life-threatening Polymorphic Ventricular Tachycardia and Rhabdomyolysis

Cited by 11 publications

References 14 publications

Electrocardiographic manifestations in severe hypokalemia

Electrocardiographic manifestations in severe hypokalemia

Thyrotoxic periodic paralysis complicated by life-threatening acute hypercapnic respiratory failure in a Chinese male with painless thyroiditis

Rhabdomyolysis in a Patient with Severe Hypothyroidism

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