Case of thyrotoxic periodic paralysis in a caucasian male and review of literature.

Tina K Thethi,Pankdeep Chhabra,Tuyen Nguyen,Prathima Nagireddy,Julie Mccaw,Stephanie Syu,Jay Waddadar,Rosemarie Parks,Kartik Munshi,Bonnie Katalenich,Joshua Larrazolo

doi:10.1155/2014/314262

Abstract

Objective. Thyrotoxic periodic paralysis (TPP), a known condition in Asian men, is becoming increasingly common in men from Western countries. Since suspicion for TPP as a differential in diagnosis is of utmost importance to avoid overcorrection of hypokalemia and other complications, we are reporting a case of TPP in a 25-year-old Caucasian male. Methods. The patient presented with intermittent lower extremity weakness after consumption of a large high-carbohydrate meal. Clinical examination revealed diffusely enlarged thyroid gland, no muscle power in lower extremities, tremors, and brisk deep tendon reflexes. Results. Clinical and laboratory findings were consistent with Graves' disease and the patient had hypokalemia. The patient responded to potassium repletion and was treated with propylthiouracil and propranolol. After treatment with radioactive iodine, the patient developed postablative hypothyroidism for which he was treated with levothyroxine. Conclusion. Since this condition is overlooked by physicians in Western countries, we present a case of TPP in a Caucasian male thus showing the importance of consideration of TPP in Caucasians despite its rare occurrence and the need for prompt diagnosis to avoid the danger of hyperkalemia in management of the paralytic attack in TPP patients.

Highlights

ObjectiveThyrotoxic periodic paralysis (TPP), a known condition in Asian men, is becoming increasingly common in men from Western countries
Thyrotoxic periodic paralysis (TPP), a rare condition in Western countries, is characterized by elevated thyroid hormone, hypokalemia, and muscle paralysis
Hypokalemic paralysis can occur as a deficiency due to excess loss of potassium, or in a periodic form caused by intracellular movement of potassium (hypokalemic periodic paralysis (HPP))

Summary

Objective

Thyrotoxic periodic paralysis (TPP), a known condition in Asian men, is becoming increasingly common in men from Western countries. Since suspicion for TPP as a differential in diagnosis is of utmost importance to avoid overcorrection of hypokalemia and other complications, we are reporting a case of TPP in a 25-year-old Caucasian male. The patient presented with intermittent lower extremity weakness after consumption of a large high-carbohydrate meal. Clinical examination revealed diffusely enlarged thyroid gland, no muscle power in lower extremities, tremors, and brisk deep tendon reflexes. Since this condition is overlooked by physicians in Western countries, we present a case of TPP in a Caucasian male showing the importance of consideration of TPP in Caucasians despite its rare occurrence and the need for prompt diagnosis to avoid the danger of hyperkalemia in management of the paralytic attack in TPP patients

Introduction

Patient Report

Discussion

Clinical Features

Findings

Conclusion