Case Report: Recurrent hypokalemic periodic paralysis associated with distal renal tubular acidosis (type 1) and hypothyroidism secondary to Hashimoto's thyroiditis

Abstract

Background: Hypokalemic periodic paralysis (HypoKPP) is characterized by transient episodes of flaccid muscle weakness. We describe the case of a teenaged boy with HypoKPP and hyperthyroidism due to Hashimoto's thyroiditis with initial manifestation of renal tubular acidosis. This combination is rare and little described previously in men. Case presentation: A 17-year-old boy was admitted after three days of muscular weakness and paresthesia in the lower limbs with an ascending evolution, leading to prostration. Decreased strength was found in the lower limbs without a defined sensory level, reduced patellar and ankle reflexes. Positive antithyroid antibodies were found. He received hydration treatment, IV potassium and levothyroxine, with which there was a clinical improvement. Other examinations led to the diagnosis of type 1 renal tubular acidosis. Conclusion: HypoKPP is a rare disorder characterized by acute episodes of muscle weakness. Type 1 renal tubular acidosis can occur as a consequence of thyroiditis, which is explained by the loss of potassium. This combination is unusually rare, and has not been described before in men. The etiopathogenesis of the disease as well as a dynamic explanation of what happened with the patient are discussed in this report.

Acute Hypokalemic Paralysis and Hashimoto’s Thyroiditis

“…To address the problem completely, a meticulous chase of aetiology is indispensable. The association of this condition with thyrotoxicosis is well established 2,3 , however, in the literature, hypothyroidism is rarely reported in association with AHP 2,4,5 .…”

“…7 Acquired distal renal tubular acidosis is most often associated with autoimmune diseases particularly Sjogren's syndrome, systemic sclerosis, rheumatoid arthritis and SLE. 1,5,8 Most of the other possible associations of dRTA e.g., nephrocalcinosis, tubulointerstitial diseases, multiple myeloma, medications, and toxicity can be easily ruled out by history, renal function tests and normal abdominal sonography. From the history and laboratory findings in case one, we could only associate Hashimoto's thyroiditis (HT) with dRTA and in the second case, Sjogren's syndrome in addition to Hashimoto's thyroiditis were found in association with dRTA leading to AHP.…”

“…3 However, the association of acute hypokalemic paralysis with hypothyroidism either directly or indirectly is barely reported. 2,4,5 We present two cases of AHP who were subsequently found to have hypothyroidism (Hashimoto's), The bizarre association with distal renal tubular acidosis and severe hypokalemia with autoimmune conditions like Hashimoto's thyroiditis and Sjogren's is explained. This helps the doctors to recognize the underlying pathology of AHP and ensures its effective management.…”

Hypothyroid myopathy with periodic paralysis as the main symptom: a case report and literature review

“…Among these patients, case 7 stopped taking levothyroxine without authorization 3 weeks after initial treatment, and developed more severe muscle weakness with hypokalemia 1 week after drug withdrawal. The patient was readmitted for potassium, alkali, and thyroxine supplementation, and the symptoms were relieved (17).…”

Hypokalemic periodic paralysis and renal tubular acidosis in a patient with hypothyroid and autoimmune disease

“…Muscle weakness depends on changes in serum potassium level (<3.5 mmol/dL) which can be due to primary or secondary causes. Primary causes are generally autosomal dominant, while secondary causes include diuretic use, loss from the gastrointestinal tract, renal tubular acidosis (RTA), primary hyperaldosteronism, Barter's syndrome, hyperthyroidism, and hypothyroidism [ 3 ].…”