Thyrotoxic hypokalaemic paralysis in a Black man

Salifu, Moro O.; Otah, Kenneth E.; Carroll, Hugh J.; Ifudu, Onyekachi; Friedman, Eli A.; Oh, Man S.; Aytug, Serhat

doi:10.1093/qjmed/94.11.659

Cited by 13 publications

(12 citation statements)

References 11 publications

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“…The genetic basis of TPP has been studied: an association with the HLA-DRw8 gene in Japanese patients and the A2BW22 and AW19B17 genes in Chinese patients has suggested the possibility that these haplotypes may serve as genetic markers 3. Some other human leukocyte antigen subtypes (B5, BW46) and genetic mutations (KCNE3) have also been associated with TPP 4. The high incidence of this disorder in the Asian population suggests that although the basic defect may be genetically determined, it manifests itself only when challenged by thyrotoxicosis.…”

Section: Discussionmentioning

confidence: 99%

Pituitary macroadenoma: a rare cause of thyrotoxic hypokalaemic periodic paralysis

et al. 2013

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Thyrotoxic hypokalaemic periodic palsy (THPP) is a well-recognised but under-diagnosed complication of hyperthyroidism and is commonly seen in Asian males. Patients usually present fully conscious with acute onset of severe motor weakness. Baseline investigation reveals severe hypokalaemia due to Na(+)/K(+) ATPase overactivity causing a massive influx of intracellular potassium ions. The most common cause of THPP identified in the medical literature is Graves' disease. We report an interesting and unusual case of THPP due to previously undiagnosed hyperthyroidism secondary to a pituitary macroadenoma. The patient was consequently found to have a tumour secreting gonadotropin and thyrotropin.

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Section: Discussionmentioning

confidence: 99%

Pituitary macroadenoma: a rare cause of thyrotoxic hypokalaemic periodic paralysis

et al. 2013

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“…These include HLA-A2, Bw22, Aw19, and B17 in Singapore Chinese, 2,3 B5 and Bw46 in Hong Kong Chinese, 2,3,14 and DRw8 in Japan. 14 Additionally, multiple mutations have been identified in TPP. Lin and colleagues 3 reported 3 single nucleotide polymorphisms were noted in Ca(v)1.1 when compared with controls without the disease.…”

Section: Reviewmentioning

confidence: 99%

Fatal Dysrhythmia Secondary to Thyrotoxicosis Periodic Paralysis in a 24-Year-Old White Male

Wreford¹,

Lambourne

2007

Lab Med

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Thyrotoxicosis hypokalemic periodic paralysis is a rare autosomal recessive condition most commonly seen in Asian populations. 1,2 The disease shows a marked male predominance 2,3 and is characterized by periodic episodes of paralysis and weakness. The authors present a rare case of a fatal cardiac dysrhythmia secondary to the disease. Case PresentationA 24-year-old white male presented to the emergency department with acute weakness of the legs. Upon waking, the patient was unable to move his legs, although he noted no sensory loss to the legs. He stated that he had mild weakness with some cramping of the legs for 1 week prior without sensory decrease. The cramping was particularly noticeable at rest. The patient also complained of weakness of the left arm and an inability to void urine.A review of the patient's clinical history showed a similar episode a year previous to the current episode. At that time, the episode lasted 2 to 3 days and resolved spontaneously. A family relative, who was a physician, made a diagnosis of dehydration. It was suggested that the patient try Pedialyte or bananas to relieve the symptoms. At this point, the patient began eating 2 bananas per day.The patient also reported occasional blurring of his vision. No loss of memory or consciousness was noted. The patient had no history of seizures. A history of hyperthyroidism, hypertension, and a possible herniated disc 6-years previously were noted. The herniated disc was treated and resolved with a cortisone injection. The patient's family and social history were negative for drug use and smoking. The patient had a recent travel history to Colorado for 3 months from which the patient had returned 2 weeks prior to presentation.On physical examination, the patient was a well-developed and well-nourished white male who was alert and anxious. The patient's blood pressure was 134/69 with a pulse of 150. The patient's temperature was 97.9°F. The patient's respirations were 28/min. His thyroid was reported as palpably enlarged.While a neurologic examination of the patient showed flaccid lower extremities with an absence of ankle and knee reflexes, the patient retained sensation within the affected limbs. After 3 hours, the patient's leg strength had significantly improved and his deeptendon reflects had returned. The patient was alert and fully oriented, there was no alteration of speech, and the patient followed commands without difficulty. The patient's pupils were equal round and reactive to light. No nystagmus or alteration in extraocular movements was noted. No facial asymmetry was noted.Initial laboratory values in the emergency department were as follows: potassium = 2.9 mM/L, sodium = 140 mM/L, total CO 2 = 25 mM/L, serum glucose = 122 mg/dL, ESR = 15 mm/hour, TSH = 0.05 uIU/mL, WBC = 9.0 K/uL with a normal differential count, Hct = 42.5%, Hgb = 13.9g/dL, MCV = 78 fL, PLT = 229 K/dL.Magnetic resonance images (MRIs) of the cervical and thoracic spine were performed, with and without contrast. These showed a small left paramedial disc her...

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“…It is an uncommon disorder characterized by simultaneous thyrotoxicosis, hypokalaemia, and recurrent episodes of limb paralysis without alteration in consciousness [1][2][3][4]. TPP affects mainly men of Asian descent.…”

Section: Introductionmentioning

confidence: 99%

“…TPP affects mainly men of Asian descent. It begins at 20-40 years of age [3,4]. It has also been reported in Caucasians, Native American Indians, Blacks and Aborigines [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%