Management of hypokalemia in patients with thyrotoxicosis periodic paralysis in Soetomo general hospital: A case report

INTRODUCTION: The prevalence of Graves' disease varies widely between 21 and 80% of all cases of hyperthyroidism. Research conducted in 2018 at the Dr. Soetomo Regional General Hospital Surabaya found Graves' disease in as many as 66.7% of all cases of hyperthyroidism. Thyrotoxicosis Periodic Paralysis (TPP) is a disorder characterized by reversible muscle weakness and paralysis, accompanied by hypokalemia, which usually accompanies hyperthyroidism, mostly caused by Graves' disease. Management of severe hypokalemia in TPP is challenging. CASE ILLUSTRATION: male, 29 years patient complained that both lower legs felt weak in the last 6 hours before coming to the hospital emergency department. The patient was diagnosed with hyperthyroidism in 2018. A fine tremor was found, and the patient was admitted to the hospital for 4 days and routinely controlled at the endocrine polyclinic. CLINICAL DISCUSSION: The underlying disease or causative etiology of thyrotoxicosis must be determined before treatment is conducted. The main concern when performing potassium replacement therapy is the occurrence of rebound hyperkalemia because this hypokalemia condition is caused not by total potassium depletion. CONCLUSION: The principles of management for thyrotoxicosis periodic paralysis are proper diagnosis, exclusion of other causes of paralysis, and other causes of hypokalemia, slow and gradual correction of hypokalemia, and close and careful clinical monitoring, ECG, and laboratory.