SUN-LB098 Mimic Presentation of Neuromuscular Symptoms in Thyrotoxic Periodic Paralysis in Hispanic Male

Abstract

Introduction: Thyrotoxic periodic paralysis (TPP) is a rare condition characterized by sudden paralysis with profound hypokalemia. Clinical Case: A 34 year-old obese Hispanic male presented to ED with sudden onset of generalized weakness and numbness of bilateral upper & lower extremities for one day. The patient was not able to get up when he woke up in the morning. He described having blurry vision, more severe on the right side, which was associated with right retroocular pain. He reported over twenty pounds of weight loss within past two months, accompanied with intermittent episodes of watery diarrhea, palpitations, restlessness, mild headache, and dizziness. He denied loss of consciousness, urinary or fecal incontinence, fever, cough or recent respiratory infection. Past medical history included gastritis. He reported no recent trauma, injury or hospitalization. No smoking, alcohol abuse or illicit drug use. On physical examination, the patient was having mild respiratory distress. Right eye exophthalmos and normal cardiopulmonary examination were noted. Neck examination showed no thyroid gland enlargement. Neurological findings revealed cranial nerve and sensory examination intact, but all four limbs were flaccid and motor strength of all extremities was 1/5. Deep tendon reflex was absent. Initial blood test on admission showed Potassium 1.9 mmol/l, Phosphorus 2 mg/dl, Magnesium 1.9 mg/dl, Lactic acid 4.6 mmol/l, TSH 0.005 mIU/l, Free T3: 8.80 pg/ml, Free T4: 2.3 ng/ml, and TBG 14.1 mcg/dl. Thyroid peroxidase was positive. EKG revealed sinus tachycardia. ABG indicated primary respiratory acidosis. Lumbar puncture was normal and ruled out Guillain-Barré syndrome and, viral or bacterial meningitis. Thyroid sonogram showed heterogeneous thyroid with no nodules. CT head without contrast showed no evidence of intracranial hemorrhage. MRI brain revealed no intracranial mass. MRI lumbar & thoracic spine showed a normal finding. After the aggressive replacement of potassium chloride, the muscle weakness improved significantly, and methimazole was initiated. The patient was admitted to ICU for close monitoring and electrolyte management. Conclusion: Thyrotoxicosis periodic paralysis (TPP) is a rare condition that manifests through acute paralysis, and hypokalemia in the presence of hyperthyroidism (1). It is usually found in relatively young Asian population, but also the occurrence has increased in the Hispanic population recently. Early recognition of TPP in a patient with unexplained hypokalemia and painless generalized weakness, is imperative to demand thyroid studies to rule out this condition. Close electrolyte management is important rebound hyperkalemia and life-threatening arrhythmias. Reference: (1) Meseeha M et al. Thyrotoxic periodic paralysis: a case study and review of the literature. J Community Hosp Intern Med Perspect. 2017;7(2):103-106. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.