Toxic Thyroid Adenoma Presenting as Hypokalemic Periodic Paralysis

Tagami, Tetsuya; Usui, Takeshi; Shimatsu, Akira; Naruse, Mitsuhide

doi:10.1507/endocrj.k07-126

Cited by 14 publications

(9 citation statements)

References 55 publications

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“…3 Thyroid hormone, b-adrenergic catecholamine and insulin can increase the pump activity in skeletal muscles, liver or kidneys. 5 This leads to a shift of potassium into the cells, manifested as low serum potassium, as seen in our patient, but without changing the total body potassium level. This may explain why weakness resolves when potassium returns to the extracellular space.…”

Section: Discussionsupporting

confidence: 60%

“…Moreover, mutations in the ionic channel genes such as CACNA1S, SCN4A and KCNE3 have been reported in the FHPP. 5 Definitive treatment of TPP consists in the management of thyrotoxicosis by medical therapy, surgery or radioactive iodine therapy. Treatment for an acute attack is potassium administration, but excessive doses of potassium can lead to hyperkalemia once potassium shifts to the extracellular space.…”

Section: Discussionmentioning

confidence: 99%

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Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Barahona¹,

Vinagre²,

Sojo³

et al. 2009

Clinical Medicine & Research

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Case ReportThyr otoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. TPP is often not recognized at first attack due to a very low prevalence among the Caucasian population and usually mild symptoms of hyperthyroidism. We report a case of TPP due to Graves' disease in a Caucasian male, who presented with 4 paralytic episodes before the diagnosis was made. Case ReportA 37-year-old Caucasian man was admitted at the hospital for evaluation of episodic muscular weakness. He recalled four similar episodes in the previous 4 months, which started during sleep or post-exercise rest. Attacks consisted of flaccid muscle weakness that varied from mild proximal leg weakness to quadriparesis, involving mainly the lower-limbs. Three attacks resolved spontaneously over 2 to 8 hours. Hypokalemia (2.3 mEq/L) and mild hypomagnesemia (1.53 mg/dL) were documented in one episode and managed with administration of intravenous potassium chloride in the emergency department. In this attack, proximal flaccid quadriparesis 2/5 was observed, with normal reflexes and sensory examination. The electrocardiogram was normal.Two weeks later (between episodes) laboratory studies revealed normal renal and hepatic function, and the following results: serum sodium 143 mEq/L (136-145), potassium 3.6 mEq/L (3.50-5.10), calcium 9.03 mg/dL (8.27-9.80), albumin 34.5 g/L (34-48), urine sodium 77 mEq/L (25-150), urine potassium 93mEq/L (17-83). He had no significant personal or familial medical history and he was not taking any medication. He related weight loss, distal tremor, and heat Keywords: Hyperthyroidism; Hypokalemia; Thyrotoxic periodic paralysisWe describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Barahona¹,

Vinagre²,

Sojo³

et al. 2009

Clinical Medicine & Research

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“…Graves' disease was distinguished from painless thyroiditis using Tbii and radioiodine thyroid scintigram [9,10], if necessary, based on the Japan Thyroid Association's guidelines for the diagnosis of graves' disease and painless thy-HDL-C decreased with aging. Because TT and OH (see Patients and Methods about the classification) may greatly influence these parameters, we also examined these relationships within eu and sH, and the similar tendencies were observed.…”

Section: Patientsmentioning

confidence: 99%

Lipid Profiles in the Untreated Patients with Hashimoto Thyroiditis and the Effects of Thyroxine Treatment on Subclinical Hypothyroidism with Hashimoto Thyroiditis

et al. 2010

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HypercHolesterolemia is a commonly experienced metabolic disorder and it causes arteriosclerosis. Recently, new therapeutic reagents such as statins have been created and primary hypercholesterolemia is effectively treated with these reagents. However, statins are not low priced and may induce rare but serious side effects such as rhabdomyolysis. abstract. To evaluate the prevalence of dyslipidemia in the population of Hashimoto thyroiditis, we reviewed medical records on the consecutive 1181 cases with adult Hashimoto thyroiditis and 830 cases were adopted for the study. First, the serum TSH level increased and serum free T4 level decreased, slightly but significantly, with increasing age. There were significant positive correlations between serum TSH levels and lipid parameters such as total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), non-HDL-C and LDL-C/HDL-C ratio (L/H). In contrast, there were significant negative correlations between serum free T4 levels and all of these lipid parameters. According to the thyroid function, the cases were classified into 4 groups such as thyrotoxicosis (TT), euthyroidism (EU), subclinical hypothyroidism (SH) and overt hypothyroidism (OH). TC, HDL-C, non-HDL-C and LDL-C of TT were significantly lower than those in EU. In contrast, TC, TG, non-HDL-C, LDL-C, L/H and age of OH were significantly higher than those in EU. Interestingly, LDL-C and L/H of SH were significantly higher compared with EU. Thirty-two of SH patients were treated with small doses of levothyroxine and the effects on the lipid profile were examined. The TC, non-HDL-C, LDL-C and L/H were significantly decreased after treatment. In conclusion, the prevalence of dyslipidemia increases along with hypofunction of the thyroid and T4 replacement therapy may improve lipid profile in the cases of SH with Hashimoto thyroiditis.

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“…Patients with TPP have been reported with thyroiditis (3, 4), toxic adenoma (5), toxic nodular goiter (9), TSH-secreting pituitary adenoma (10, 11), ingestion of T4 or T3 (6, 12, 13), inadvertent iodine excess (14), subacute thyroiditis of de Quervain (15), amiodarone therapy (16), radiation thyroiditis with Graves' disease (17) and nutraceuticals containing triatricol (18). …”

Section: Discussionmentioning

confidence: 99%

“…The most common cause of TPP in thyrotoxicosis is Graves' disease, although TPP can occur with any form of thyrotoxicosis (1, 2). It is less commonly associated with thyroiditis (3, 4), toxic adenoma (5), T4 ingestion and iodine excess (6). However, very few cases such as this one have been reported as far as we know that thyrotoxic periodic paralysis associated with painless thyroiditis.…”

Section: Introductionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis Due to Painless Thyroiditis

Ahn

et al. 2012

J Korean Med Sci

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Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.

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Toxic Thyroid Adenoma Presenting as Hypokalemic Periodic Paralysis

Cited by 14 publications

References 55 publications

Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Lipid Profiles in the Untreated Patients with Hashimoto Thyroiditis and the Effects of Thyroxine Treatment on Subclinical Hypothyroidism with Hashimoto Thyroiditis

Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis Due to Painless Thyroiditis

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