Iodine-induced thyrotoxic hypokalemic paralysis after ingestion ofSalicornia herbace

Abstract

A 56-year-old Korean man visited to emergency room due to paroxysmal flaccid paralysis in his lower extremities. There was no family or personal history of periodic paralysis. His initial potassium levels were 1.8 mmol/L. The patient had been taking Salicornia herbacea for the treatment of diabetes and hypertension. Results of a thyroid function test were as follows: T3 ¼ 130.40 ng/dL, TSH ¼ 0.06 mIU/L, and free T4 ¼ 1.73 ng/dL. A thyroid scan exhibited a decreased uptake (0.6%). His symptoms clearly improved and serum potassium levels increased to 4.4 mmol/L by intravenous infusion of only 40 mmol of potassium chloride. Eight months after the discontinuation of only Salicornia herbacea, the patient's thyroid function tests were normalized. Large amounts of iodine can induce hypokalemic thyrotoxic paralysis and it may be necessary to inquire about the ingestion of iatrogenic iodine compounds, such as Salicornia herbacea.

Salicornia bigelovii, S. brachiata and S. herbacea: Their Nutritional Characteristics and an Evaluation of Their Potential as Salt Substitutes

“…However, there has been some incidence of this hypokalemic rare disease being referred to as “throtoxic periodic analysis” (TPP), which has been associated with hyperthyroidism. As a result of this, there have been recommendations about being careful with iatrogenic iodine compounds, especially when consuming S. herbacea [ 108 ].…”

“…S. herbacea are also unique for having a salty taste and a smaller quantity of sodium, as well as their nutritional quality of fatty acid content [ 4 , 46 , 109 , 110 ], especially polyunsaturated [ 111 , 112 ], in addition to minerals [ 4 , 16 , 20 , 53 , 103 , 105 , 108 , 113 , 114 ], vitamins [ 4 , 53 ] and antioxidants [ 4 , 7 , 20 , 29 , 105 ], which enrich their nutritional profile [ 4 ] and make Salicornia species S. herbacea , S. bigelovii and S. brachiata good options for making salt substitutes.…”

Salicornia: evaluating the halophytic extremophile as a food and a pharmaceutical candidate

“…In addition, Salicornia might contain iatrogenic iodine. A case study resulted that hyperconsumption of S. herbacea can lead to excess iodine in body, causing hypokalemic thyrotoxic paralysis (Yun et al 2014 ). Discontinuation of Salicornia intake restored the potassium level and normalized thyroid imbalance (Yun et al 2014 ).…”

Intravenous Iodinated Contrast Induced Thyrotoxic Periodic Paralysis: A Case Report

“…Our patient, however, did not experience any symptoms of hyperthyroidism during the attack apart from systolic hypertension in the emergency room, which made the diagnosis challenging. Most patients with TPP have only mild or subclinical hyperthyroidism but our patient had a significant hyperthyroidism thyroid profile with suppressed TSH and FT4 double the upper normal range detected two months before his presentation [ 5 , 14 ]. This could have facilitated the development of TPP in our patient.…”

“…ere are multiple reported cases of iodine-induced TPP after ingestion of amiodarone and other iodine-containing substances, such as radioactive iodine and kelp [1,[14][15][16][17][18]. However, only one case of TPP following administration of intravenous iodine-containing contrast has been reported which was also managed urgently with potassium replacement [19].…”