Thyrotoxic Periodic Paralysis with Hypokalemia in an Adult Male from Nepal: A Case Report

Sabina Khadka,Pravakar Dawadi,Indu K.C,Pravash Budhathoki,Rabindra Jang Rayamajhi

doi:10.31729/jnma.4763

Abstract

Thyrotoxic periodic paralysis is rare complication of hyperthyroidism characterized by the sudden onset of hypokalemia and muscle paralysis. It is typically present in young Asian males. There are very few literatures regarding the occurrence of thyrotoxic hypokalemic periodic paralysis in Nepal. We reported a case of a 35-year-old male presented with the chief complaints of weakness of all four limbs of 1 day duration. He was diagnosed as a case of hyperthyroidism in the past, received treatment for 6 months and left medications on his own 6 months ago. Evaluation during admission revealed severe hypokalemia with serum potassium level 1.3mEq/l and high serum Triiodothyronine (>20.00µg/L) and low serum Thyroid Stimulating Hormone (<0.01µg/L). Potassium supplements resolved muscle weakness and the patient was restarted with anti-thyroid drugs. Hence, hypokalemic paralysis is a reversible cause of paralysis and high index of suspicion as well as timely interventions are required to prevent potential harm. Keywords: hyperthyroidism; hypokalemia; muscle paralysis; thyrotoxic periodic paralysis.

Highlights

Thyrotoxic Periodic Paralysis (TPP) is potentially lethal complication of hyperthyroidism and usually presents with acute muscle weakness and hypokalemia.1 It is a disorder most commonly seen among Asian males.2,3 it is essential to differentiate TPP from familial hypokalemic periodic paralysis, a frequent cause of periodic paralysis in caucasians and western countries.4Diagnosis is confirmed by laboratory parameters such as the presence of both hypokalemia and elevated level of thyroxine and triiodothyronine
Our patient with TPP had a secondary cause i.e. he was diagnosed with hyperthyroidism around 1 year back and received treatment for 6 months with poor drug compliance
Though hyperthyroidism is more common among females, TPP is highly prevalent among young Asian males

Summary

Introduction

Thyrotoxic Periodic Paralysis (TPP) is potentially lethal complication of hyperthyroidism and usually presents with acute muscle weakness and hypokalemia.1 It is a disorder most commonly seen among Asian males.2,3 it is essential to differentiate TPP from familial hypokalemic periodic paralysis, a frequent cause of periodic paralysis in caucasians and western countries.4Diagnosis is confirmed by laboratory parameters such as the presence of both hypokalemia and elevated level of thyroxine and triiodothyronine. Khadka et al Thyrotoxic Periodic Paralysis with Hypokalemia in an Adult Male from Nepal: A Case Report loss of 10-15 kg over past 6 months despite normal appetite.

Results

Conclusion