Abstract
Thyrotoxic periodic paralysis (TPP) is an unusual complication of hyperthyroidism that may cause diagnostic difficulties due to its clinical feature that may be similar to other diseases. However, TPP can be detected early based on the weakness presentation, which generally affects the lower extremity with proximal muscle involvement, and, additionally, the ECG findings presenting hypokalemia characteristics. This case illustrates a young Indonesian male presenting in the emergency department with paralysis and typical ECG findings suggesting TPP. Early identification of TPP is necessary for executing proper treatment and reducing complications.
Highlights
Thyrotoxic periodic paralysis (TPP) is characterized by short-term recurring bouts of flaccid muscular paralysis affecting the proximal muscles more than the distal muscles [1]
The most common etiology of TPP is due to Graves' disease, but other conditions, such as subacute thyroiditis, toxic nodular goiters, thyroid-stimulating hormone (TSH)-secreting tumor, amiodarone-induced thyrotoxicosis, and factitious hyperthyroidism, can induce TPP [3,4,5,6]
The underlying mechanism in TPP is involving a hyperadrenergic, hyperthyroid state that stimulates sodium-potassium (Na/K) ATPase pump activity leading to intracellular potassium shift and hypokalemia [7]
Summary
Thyrotoxic periodic paralysis (TPP) is characterized by short-term recurring bouts of flaccid muscular paralysis affecting the proximal muscles more than the distal muscles [1]. A 31-year-old male accompanied by his relative presented to the emergency department in a wheelchair He complained about his sudden limb weakness on the entire upper and lower extremities. The patient denied any previous strenuous exercises, food with a lot of sugars or carbohydrates, licorices, stress, and cold temperatures that may trigger the events This sudden attack was previously felt three weeks ago when he was going to the bathroom in the morning and suddenly felt a similar limb weakness, making him fall to the ground. Similar complaints in the family were denied by the patient Upon physical examination, he was alert (Glasgow Coma Scale score: 15), with blood pressure of 100/70 mmHg, and he was tachycardic (120 BPM). A nerve conduction velocity test was not performed On laboratory examination, his serum potassium level was 1.26 mmol/L. The patient was diagnosed with Graves' disease and discharged on the following day with antithyroid medication
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