Thyrotoxic periodic paralysis as an initial presentation of Graves’ disease in a Saudi patient

Alqahtani, SF; Aleithan, MM

doi:10.1136/bcr-2017-220224

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Thyrotoxic periodic paralysis has a male preponderance [ 5 ]. Other primary periodic paralysis types are hyperkalemic periodic paralysis and Anderson-Tawil syndrome [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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An Interesting Case of Weakness and Atrial Tachycardia in the Emergency Department: Thinking Beyond Hearts and Minds

Yahya¹,

Ahmed²,

Qayyum³

2023

Cureus

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Thyrotoxic periodic paralysis is a rare but life-threatening presentation of hyperthyroidism that manifests with sudden, painless episodes of muscle weakness due to hypokalemia. We present the case of a middle-aged Middle Eastern female who attended our Emergency Department with sudden onset weakness to the lower limbs, resulting in her inability to walk. She had a power of 1/5 in the lower limbs, and subsequent investigations showed a low potassium level, and primary hyperthyroidism secondary to Grave's disease was diagnosed. A 12-lead electrocardiogram showed atrial flutter with a variable block, along with U waves. The patient reverted to sinus rhythm following administration of potassium replacement and was also treated with Propanalol and Carbimazole. The patient made a full neurological recovery. Emergency physicians and all frontline healthcare workers should be aware that electrolyte problems can cause paralysis. Furthermore, hypokalemic periodic paralysis can be caused by an undiagnosed thyrotoxic state. Be aware that if left untreated, hypokalemia can cause serious atrial and ventricular arrhythmias. Achieving a euthyroid state and blunting hyperadrenergic stimulation, in addition to replacing potassium, all help to fully reverse muscle weakness.

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“…Thyrotoxic periodic paralysis has a male preponderance [ 5 ]. Other primary periodic paralysis types are hyperkalemic periodic paralysis and Anderson-Tawil syndrome [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the prevalence of hyperthyroid hypokalemic periodic paralysis in the UAE is difficult to estimate due to population migration [ 5 ], the incidence in Asian countries (92%) is approximately 10-20 times higher than non-Asian ethnic populations [ 3 ]. Cases have been sporadically described in the Arab population [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

An Interesting Case of Weakness and Atrial Tachycardia in the Emergency Department: Thinking Beyond Hearts and Minds

Yahya¹,

Ahmed²,

Qayyum³

2023

Cureus

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show abstract

“…For patients without a history of hyperthyroidism, the measurement of thyroid functions should also be considered. Some patients report with TPP as an initial presentation of hyperthyroidism[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilator prevents intubation in thyrotoxic hypokalemic periodic paralysis-associated respiratory failure: A case report and literature review

Hung

Liu

et al. 2021

Tzu Chi Med J

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Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, often presents with limb muscle paralysis, hypokalemia with elevated-free T3, T4, and low thyroid-stimulating hormone (TSH). We herein reported an unusual presentation of TPP with acute hypercapnic respiratory failure. A 28-year-old female had complaints of nausea and vomiting. Laboratory investigations showed a serum potassium level of 1.2 mEq/L. Thyroid function test revealed the TSH level of 0.021 μlU/mL and free T4 at 2.01 ng/dL. She suddenly suffered from dyspnea and drowsiness. Acute hypercapnic respiratory failure with CO 2 retention was found. Noninvasive ventilation was used. Rapid correction of hypokalemia and administration of propylthiouracil, propranolol, and 5% Lugol's solution were performed. After the normalization of potassium levels, the patient's respiratory pattern stabilized and noninvasive ventilator (NIV) use was discontinued. Respiratory failure is an unusual but lethal complication of TPP. Rapid correction of hypokalemia and temporarily NIV can successfully avoid endotracheal intubation for respiratory failure.

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“…[3] reported a patient known to have Graves' disease who came to their ED with the clinical profile of HPP without the signs and symptoms of thyrotoxicosis. TTP and hypokalemia can be the initial presentation of thyrotoxicosis and Graves' disease [4][5][6]. Rebound hyperkalemia is a known complication during the treatment of TTP and HPP.…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis Presenting with Hypokalemia: A Case Report

Aseri

2020

AJBSR

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Background: Thyrotoxic periodic paralysis (TPP), a serious complication of hyperthyroidism, is a common etiology of secondary hypokalemic periodic paralysis (HPP). In this study, we present a case report of a patient who presented to our ED with weakness and hypokalemia and was found to have severe hyperthyroidism.Case presentation: A 29-year-old Chinese man presented to our Emergency Department complaining of feeling very weak and tired for 8 hours. The weakness was limited to his four limbs. On physical examination, he was conscious and oriented to place, persons, and time. Upper and lower limb exams showed a power of 4/5 with normal sensation and an absence of Babinski signs. The initial blood work was normal, except for mild hypokalemia; therefore, the initial plan was to start him on one liter of IV normal saline mixed with 40 mEq KCl over 4 hours before repeating the laboratory investigations. The repeated blood work showed a drop in his potassium level to 2.2 mmol/L, indicating the need for further potassium replacement and extensive blood work, including a thyroid function test, which showed severe hyperthyroidism. The patient was admitted to the critical care unit, where his vital signs were monitored continuously, and he received KCl replacement and began propranolol and carbimazole treatment.Conclusions: TPP should be a differential diagnosis for patients with unexplained hypokalemia and weakness, even in the absence of clinical features of hyperthyroidism.

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Thyrotoxic periodic paralysis as an initial presentation of Graves’ disease in a Saudi patient

Cited by 3 publications

References 11 publications

An Interesting Case of Weakness and Atrial Tachycardia in the Emergency Department: Thinking Beyond Hearts and Minds

An Interesting Case of Weakness and Atrial Tachycardia in the Emergency Department: Thinking Beyond Hearts and Minds

Noninvasive ventilator prevents intubation in thyrotoxic hypokalemic periodic paralysis-associated respiratory failure: A case report and literature review

Thyrotoxic Periodic Paralysis Presenting with Hypokalemia: A Case Report

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