Thyrotoxic Periodic Paralysis with Sensory Deficits in Young African American Male: A Case Report and Literature Review

Abstract

Thyrotoxic periodic paralysis is a sporadic entity characterized by hypokalemia and paralysis in the setting of hyperthyroidism. TPP is most commonly described in young Asian males. Studies have shown an association with mutations affecting inward rectifying potassium channels. The pathophysiology involves Na + -K + - ATPase channel causing an increased intracellular shift of potassium ions in the hyperthyroid state and in the presence of another precipitating condition. Most cases of thyrotoxic periodic paralysis are defined in young Asian males of 20–40 years of age, here we present an interesting case of thyrotoxic periodic paralysis in 32-year-old African American male, who presented with sudden onset weakness in the bilateral lower extremity and left upper extremity. Interestingly, the patient also has sensory deficits, a feature not known to be associated with thyrotoxic periodic paralysis.

Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia

“…Hyperthyroidism should be controlled to prevent attacks of muscle weakness [ 10 ]. Only a few cases of THPP have been reported from African populations [ 11 ].…”

Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

“…2,6 Thyroid hormone activates the thyroid response element in cellular nuclei, thereby inducing Na/K ATPase gene transcription. 4 It also increases beta-adrenergic receptor sensitivity, which itself increases Na/K ATPase pump activity in skeletal muscles. 7 The end result from both of these processes is increased intracellular shift of potassium and depleted extracellular potassium stores.…”

“…7 The end result from both of these processes is increased intracellular shift of potassium and depleted extracellular potassium stores. 4 Eventually there is hyperpolarization of the muscle cell membranes, leading to muscle paralysis and clinical weakness. 7 Young and middle aged adult men appear to be most affected by TPP, which may be explained by testosterone's stimulatory effects on the Na + -K + ATPase, unlike estrogen, which decreases its activity.…”

“…Plantar reflexes were normal H ypokalemic thyrotoxic periodic paralysis (TPP) is a rare endocrine disorder characterized by the triad of thyrotoxicosis, hypokalemia, and acute muscle weakness, and it is most often encountered at night. [1][2][3][4][5] Although thyrotoxicosis affects females nine times more frequently than males, TPP occurs more commonly in men (male to female ratio ranging from 17:1 to 70:1), and it occurs in higher rates in males of Asian and Polynesian descent. [1][2][3]5 The prevalence in North America is 0.1%-0.2%, but the incidence is expected to rise in the future in both Europe and North America due to immigration patterns.…”

Hypokalemic Paraparesis Progressing to Quadriparesis in a Case of Intradural Spinal Tumor

“…The syndrome of hypokalemic paralysis includes a heterogeneous group of disorders characterized clinically by hypokalemia and acute systemic weakness. Most cases are due to familial or primary hypokalemic periodic paralysis; sporadic cases are associated with numerous other conditions including barium poisoning, hyperthyroidism, renal disorders, certain endocrinopathies, gastrointestinal potassium losses, Sjogren's syndrome, and infectious pathologies such as dengue fever and Yersinia enterocolitica infection [4,[11][12][13][14][15]. In our case, the patient presented to us in progressive condition, and therefore, initially, it appears to have paraparesis which confuses physician as symptoms were correlating with the lesion.…”