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

Abstract

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.

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Potassium Supplementation to Prevent Severe Hypokalemia and Paralysis after High-Dose Methylprednisolone for Ophthalmopathy in Uncontrolled Graves Disease: A Case Report

“…Similar cases have been described in the literature. [10][11][12] Most of these involved young men of Asian descent presenting to the emergency department with abrupt onset of severe paralysis of the lower limbs or all limbs. Laboratory investigations revealed underlying uncontrolled thyrotoxicosis and severe hypokalemia resulting in the diagnosis of TPP, which likely also explains this patient's severe hypokalemia-related paresis.…”

Chronic Alcohol Abuse-Induced Hypokalemia Might Lead to Delayed Diagnosis or Misdiagnosis of Thyrotoxic Periodic Paralysis

“…Hot weather, increased exercise, and consumption of large numbers of high-carbohydrate meals and alcoholic drinks are typical causes [ 8 , 9 ]. TPP most commonly presents as rapid-onset, transient, symmetrical muscle weakness and fatigue that are associated with hypokalemia [ 10 ]. Excessive thyroid hormones can directly alter the cell membrane permeability to potassium by increasing Na+/K+ ATPase activity that induces massive abnormal potassium influx [ 11 ].…”