Cargando…

Thyrotoxic periodic paralysis: case report and review of the literature

INTRODUCTION: Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism. It is characterized by sudden onset paralysis associated with hypokalemia. Management includes prompt normalization of potassium, which results in resolution of the paralysis. Definiti...

Descripción completa

Detalles Bibliográficos
Autores principales: Garla, Vishnu Vardhan, Gunturu, Manasa, Kovvuru, Karthik Reddy, Salim, Sohail Abdul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Electronic physician 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122872/
https://www.ncbi.nlm.nih.gov/pubmed/30214699
http://dx.doi.org/10.19082/7174
_version_ 1783352744219770880
author Garla, Vishnu Vardhan
Gunturu, Manasa
Kovvuru, Karthik Reddy
Salim, Sohail Abdul
author_facet Garla, Vishnu Vardhan
Gunturu, Manasa
Kovvuru, Karthik Reddy
Salim, Sohail Abdul
author_sort Garla, Vishnu Vardhan
collection PubMed
description INTRODUCTION: Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism. It is characterized by sudden onset paralysis associated with hypokalemia. Management includes prompt normalization of potassium, which results in resolution of the paralysis. Definitive treatment of hyperthyroidism resolves TPP completely. CASE PRESENTATION: A 23-year-old African American male patient presented to the emergency room at the University of Mississippi Medical Center, USA in November 2016 with sudden onset quadriplegia. He also endorsed a history of weight loss, palpitations, heat intolerance and tremors. The patient reported similar episodes of quadriplegia in the past, which were associated with hypokalemia and resolved with normalization of potassium levels. Physical examination was significant for exophthalmos, smooth goiter with bruit consistent with the diagnosis of Graves’ disease. Laboratory assessment showed severe hypokalemia, hypomagnesemia, suppressed thyroid stimulating hormone (TSH) and high free thyroxine (T4). Urine potassium creatinine ratio was less than one, indicating transcellular shift as the cause of hypokalemia. After normalization of potassium and magnesium, the paralysis resolved in 12 hours. He was started on methimazole. On follow up, the patient was clinically and biochemically euthyroid with no further episodes of paralysis. TAKE-AWAY LESSON: TPP is a rare and reversible cause of paralysis. Physicians need to be aware of the diagnostic and treatment modalities as delayed recognition in treatment could result in potential harm or unnecessary interventions.
format Online
Article
Text
id pubmed-6122872
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Electronic physician
record_format MEDLINE/PubMed
spelling pubmed-61228722018-09-13 Thyrotoxic periodic paralysis: case report and review of the literature Garla, Vishnu Vardhan Gunturu, Manasa Kovvuru, Karthik Reddy Salim, Sohail Abdul Electron Physician Case Report INTRODUCTION: Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism. It is characterized by sudden onset paralysis associated with hypokalemia. Management includes prompt normalization of potassium, which results in resolution of the paralysis. Definitive treatment of hyperthyroidism resolves TPP completely. CASE PRESENTATION: A 23-year-old African American male patient presented to the emergency room at the University of Mississippi Medical Center, USA in November 2016 with sudden onset quadriplegia. He also endorsed a history of weight loss, palpitations, heat intolerance and tremors. The patient reported similar episodes of quadriplegia in the past, which were associated with hypokalemia and resolved with normalization of potassium levels. Physical examination was significant for exophthalmos, smooth goiter with bruit consistent with the diagnosis of Graves’ disease. Laboratory assessment showed severe hypokalemia, hypomagnesemia, suppressed thyroid stimulating hormone (TSH) and high free thyroxine (T4). Urine potassium creatinine ratio was less than one, indicating transcellular shift as the cause of hypokalemia. After normalization of potassium and magnesium, the paralysis resolved in 12 hours. He was started on methimazole. On follow up, the patient was clinically and biochemically euthyroid with no further episodes of paralysis. TAKE-AWAY LESSON: TPP is a rare and reversible cause of paralysis. Physicians need to be aware of the diagnostic and treatment modalities as delayed recognition in treatment could result in potential harm or unnecessary interventions. Electronic physician 2018-08-25 /pmc/articles/PMC6122872/ /pubmed/30214699 http://dx.doi.org/10.19082/7174 Text en © 2018 The Authors This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/3.0/) , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Case Report
Garla, Vishnu Vardhan
Gunturu, Manasa
Kovvuru, Karthik Reddy
Salim, Sohail Abdul
Thyrotoxic periodic paralysis: case report and review of the literature
title Thyrotoxic periodic paralysis: case report and review of the literature
title_full Thyrotoxic periodic paralysis: case report and review of the literature
title_fullStr Thyrotoxic periodic paralysis: case report and review of the literature
title_full_unstemmed Thyrotoxic periodic paralysis: case report and review of the literature
title_short Thyrotoxic periodic paralysis: case report and review of the literature
title_sort thyrotoxic periodic paralysis: case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122872/
https://www.ncbi.nlm.nih.gov/pubmed/30214699
http://dx.doi.org/10.19082/7174
work_keys_str_mv AT garlavishnuvardhan thyrotoxicperiodicparalysiscasereportandreviewoftheliterature
AT gunturumanasa thyrotoxicperiodicparalysiscasereportandreviewoftheliterature
AT kovvurukarthikreddy thyrotoxicperiodicparalysiscasereportandreviewoftheliterature
AT salimsohailabdul thyrotoxicperiodicparalysiscasereportandreviewoftheliterature