Thyrotoxic Periodic Paralysis: An Incidental Diagnosis!

Batch, Jennifer T; Jahngir, Muhammad Umair; Rodríguez, Ismael

doi:10.7759/cureus.7041

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…yrotoxic periodic paralysis (TPP) is a distinct manifestation of thyrotoxicosis where the patient develops a transient motor de cit due to acute hypokalemia. Due to the role of testosterone in the Na-K ATPase activity, TPP is more common in males, in line with our patient's gender [20]. One of the possible precipitating factors for TPP is infection.…”

Section: Discussionsupporting

confidence: 81%

COVID-19 Infection-Related Thyrotoxic Hypokalemic Periodic Paralysis

Fitriani

Susanti

Ikhsan

2022

Case Reports in Endocrinology

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SARS-CoV-2 infection induces the dysfunction of many organs including the thyroid gland through the role of ACE2 receptors as well as the consequences of the cytokine storm. Thyroid diseases such as subacute thyroidism, Graves’ disease, thyrotoxicosis, and Hashimoto’s thyroiditis have been documented in patients with SARS-CoV-2 infection. However, there are limited reports about the consequences of SARS-CoV-2 infection-related thyroid complications. We describe a case of man who was admitted to the emergency department due to repeated lower limb weakness since diagnosed with COVID-19. He had refractory hypokalemia and was treated with potassium replacement therapy for 2 months. However, the complaints continued. The patient has no history of thyroid disease, yet the laboratory result showed hyperthyroidism. Accordingly, he received oral thiamazole. As the laboratory parameters of the thyroid hormones improved, potassium levels returned to normal and the limb weakness stopped. This unusual thyroid complication should be considered in SARS-CoV-2 infection. The prompt diagnosis and appropriate therapy can reduce the burden of the disease.

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Section: Discussionsupporting

confidence: 81%

COVID-19 Infection-Related Thyrotoxic Hypokalemic Periodic Paralysis

Fitriani

Susanti

Ikhsan

2022

Case Reports in Endocrinology

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“…This condition has a male predominance which makes these genetic alterations possibly X-linked, or that sex hormones play a role in the pathophysiology. In fact, androgens are known to increase the activity of the Na/K ATPase pump, while estrogen and progesterone inhibit it [ 3 , 9 , 10 ]. Furthermore, androgens induce muscle growth and hypertrophy, which increases the amount of Na/K ATPase pumps available for stimulation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Intravenous Iodinated Contrast Induced Thyrotoxic Periodic Paralysis: A Case Report

Alrushaid

Alessa

2022

Case Reports in Endocrinology

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Thyrotoxic periodic paralysis (TPP) is an entity that has been described in the literature as a transient, symmetrical, flaccid paralysis, mainly affecting the lower limbs of patients with a current or previous history of hyperthyroidism. In most cases, Graves’ disease is the cause of hyperthyroidism. Contrast and iodine-induced TPP have been described in the literature, but only one case of intravenous contrast induced TPP has been reported. We report a case of TPP following administration of intravenous contrast for a computed tomography scan of the neck prior to lymph node excision. A 35-year-old Kuwaiti male with known Graves’ disease in remission until two months of his presentation, reported to the emergency room one early morning in December 2020. He sustained a fall from the stairs due to bilateral lower limb weakness, mostly proximal. The upper limbs were spared, and the patient did not experience any numbness or headache. His potassium was found to be 2.1 mmol/L and an electrocardiogram showed U waves and ST segment changes. He was initiated on 20 mEq of intravenous potassium chloride in 500 mL sodium chloride over one hour, following which his potassium approached normal and his weakness resolved. He was last known to be euthyroid in November 2019 but noted in October 2020 to be in the hyperthyroid state when thyroid function testing showed a thyroid-stimulating hormone of <0.005 (0.27–4.2 uIu/mL) and free thyroxine (T4) of 27.6 (7.8– pmol/L). In patients with known hyperthyroidism, more caution is required when iodine-containing substances are administered without proper evaluation of thyroid function.

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“…La gravedad de la parálisis, aunque no guarde relación con la duración ni con la gravedad de la tirotoxicosis, es directamente proporcional a la concentración de potasio [5,10], y solo la mitad de los pacientes presentan mialgias, que usualmente son leves [3,5,6]. La falla respiratoria y la muerte son poco comunes, debido a que en la mayoría de casos la función de los músculos respiratorios está preservada; sin embargo, esta complicación se ha presentado en algunos pacientes [11].…”

Section: Manifestaciones Clínicasunclassified

“…El exceso de hormonas tiroideas sensibiliza la acción de la bomba a las catecolaminas endógenas e incrementa su permanencia en las membranas celulares, incluyendo las del miocito [3,14]. Los episodios de parálisis usualmente son desencadenados por varios precipitantes, entre los más comunes están las comidas altas en carbohidratos, el alcohol, el estado de reposo luego de hacer ejercicio intenso, o situaciones de estrés excesivo [3,10,16,17] (tabla 2). Los dos primeros potencian la secreción de insulina, y el Figura 2.…”

Section: Epidemiologíaunclassified

“…Las nuevas recomendaciones para el tratamiento de la PPHT aconsejan iniciar beta-bloqueadores no selectivos de forma temprana con reposición simultánea de potasio, con la finalidad de tratar la causa subyacente de la parálisis periódica [3,5]. En varios estudios se ha descrito que la parálisis y la debilidad grave se resuelven usualmente en 2 horas, y en ocasiones pueden durar solo 30 minutos, sin hiperpotasemia de rebote [10,20,24,25]. Si se requiere administrar potasio, la dosis recomendada es 30 mEq por vía oral cada 2 horas, máximo hasta 90 mEq.…”

Section: Tratamientounclassified

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Parálisis periódica hipopotasémica tirotóxica: reporte de caso y revisión del tema

Moreno-Rozo¹,

Rosero-Arellano

García-Castaño

2020

Med. Lab.

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La parálisis periódica hipopotasémica tirotóxica, también conocida como parálisis periódica hipocalémica tirotóxica, forma parte de las parálisis periódicas primarias, y se presenta como complicación de la tirotoxicosis. Es más común en pacientes de sexo masculino y en asiáticos. Se caracteriza por episodios recurrentes de debilidad de extremidades de inicio súbito, asociados a hipopotasemia grave en un paciente con tirotoxicosis de base. Se presenta el caso de un hombre de 32 años, con obesidad, quien refiere haber presentado por varios meses episodios recurrentes de debilidad progresiva en miembros inferiores y superiores que limitaban la marcha, con mejoría espontánea. Como paraclínicos se reportaron hipopotasemia severa de 1,6 mmol/L, y un perfil bioquímico de tirotoxicosis con TSH suprimida, T3 y T4 elevadas, anticuerpos antiperoxidasa positivos y gammagrafía de tiroides con bocio difuso hipercaptante, que confirmaron el diagnóstico de una parálisis periódica hipopotasémica tirotóxica, asociada a una enfermedad de Graves. La hipopotasemia se corrigió rápidamente con la infusión de potasio intravenoso, con mejoría clínica de la debilidad. El hipertiroidismo se manejó con beta-bloqueadores, tionamidas y posteriormente con yodo radioactivo.

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Thyrotoxic Periodic Paralysis: An Incidental Diagnosis!

Abstract: Batch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 5 publications

References 12 publications

COVID-19 Infection-Related Thyrotoxic Hypokalemic Periodic Paralysis

COVID-19 Infection-Related Thyrotoxic Hypokalemic Periodic Paralysis

Intravenous Iodinated Contrast Induced Thyrotoxic Periodic Paralysis: A Case Report

Parálisis periódica hipopotasémica tirotóxica: reporte de caso y revisión del tema

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