Thyrotoxic Periodic Paralysis With Features of Andersen-Tawil Syndrome: A Case Report and Literature Review.

Beshoy Iskander,Bilal Haider Malik,Ivan Cancarevic

doi:10.7759/cureus.8169

Abstract

Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism. The pathophysiology of hyperthyroidism causing periodic paralysis involves the Na+/K+ ATPase and potassium channels. We present a case of a 30-year-old male who presented to the ED with acute onset of upper and lower limb weakness. The patient was found to have bilateral weakness in the upper and lower limbs, orbital hypertelorism, and mandibular hypoplasia. He was also found to have hypokalemia, low thyroid-stimulating hormone (TSH), elevated thyroid peroxidase antibody, and elevated thyroid-stimulating immunoglobulins. The patient’s EKG was remarkable for a prolonged QTc interval. The patient regained his muscle strength after potassium replacement in less than 24 hours. He was started on methimazole and potassium supplements. Our case is unique because it shows the possibility of the presence of Andersen-Tawil syndrome (ATS) (long QT syndrome 7), diagnosed by the presence of periodic paralysis, long QT, and dysmorphic facial features with TPP. In conclusion, thyrotoxicosis can trigger ATS; also the two syndromes can co-exist owing to the similarity in their pathophysiology.

Highlights

Thyrotoxic periodic paralysis (TPP) is one of the rare manifestations of hyperthyroidism [1,2]
Andersen-Tawil Syndrome (ATS) is a primary periodic paralysis that can present as an autosomal dominant or a sporadic disorder [4,5]
Unlike TPP, Andersen-Tawil syndrome (ATS) tends to affect multiple sites, including cardiac and skeletal cells leading to its clinical presentation of a triad of hypokalemia, prolonged QTc, and facial and skeletal dysmorphism [4,5]

Summary

Introduction

Thyrotoxic periodic paralysis (TPP) is one of the rare manifestations of hyperthyroidism [1,2]. Andersen-Tawil Syndrome (ATS) is a primary periodic paralysis that can present as an autosomal dominant or a sporadic disorder [4,5]. Unlike TPP, ATS tends to affect multiple sites, including cardiac and skeletal cells leading to its clinical presentation of a triad of hypokalemia, prolonged QTc, and facial and skeletal dysmorphism (low-set ears, mandibular hypoplasia, orbital hypertelorism) [4,5]. A 30-year-old Caucasian male with a past medical history of periodic paralysis, taking no home medications, presented to the ED with lower extremity and upper extremity weakness after drinking about ten cans of soda and energy drinks. How to cite this article Iskander B, Malik B, Cancarevic I (May 17, 2020) Thyrotoxic Periodic Paralysis With Features of Andersen-Tawil Syndrome: A Case Report and Literature Review.

Discussion

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Disclosures