Case Of Thyrotoxic Periodic Paralysis Research Articles

Thyrotoxic Periodic Paralysis – A Case Report of a Rare Cause of Paralysis in a 39-Year-Old Asian Man

Uncontrolled hyper thyroidism has a myriad of presentations. Classically, symptoms include weight loss, tremor, palpitations, shortness of breath, diarrhea, anxiety, and heat intolerance. A rare manifestation of hyperthyroidism is thyrotoxic periodic paralysis (TPP). Periodic paralysis is a musculoskeletal channelopathy manifested by episodes of painless muscle weakness often precipitated by heavy exercise, fasting, or high carbohydrate meals. Although classically associated with painless weakness; cramping, myalgias, and stiffness can also occur prior to the episodes as prodromal symptoms. Neurologic examination during an attack typically demonstrates proximal more than distal muscle weakness, and the upper extremities are more commonly affected than the lower extremities.1-4 Consciousness and sensation are preserved, and respiratory muscle involvement is exceedingly rare. Episodes of weakness can last from a few hours up to 72 hours with intermittent recovery between attacks. Patients most often have diminished deep tendon reflexes, but reflexes may be preserved in some cases. We present a case of TPP, discuss the differential diagnosis of periodic paralysis, and review the pathophysiology and management of TPP.

Fatal Case of Thyrotoxic Periodic Paralysis, Presenting as Hyperacute Ascending Paralysis and Cardiac Arrhythmia (P6.197)

Fatal Case of Thyrotoxic Periodic Paralysis, Presenting as Hyperacute Ascending Paralysis and Cardiac Arrhythmia (P6.197)

A rare cause of thyrotoxic periodic paralysis: liquorice consumption

Thyrotoxic periodic paralysis (TPP) is the most common form of acquired hypokalaemic periodic paralysis. The most common precipitating factors of the disease are a high-carbohydrate diet and exercise.1 2 Some...

A Rare Case of Thyrotoxic Periodic Paralysis Caused by TSH-Secreting Pituitary Adenoma: Case Report and Review of the Literature

A Rare Case of Thyrotoxic Periodic Paralysis Caused by TSH-Secreting Pituitary Adenoma: Case Report and Review of the Literature

Thyrotoxic Periodic Paralysis in a 20-Year-Old Nigerian Male

Background: Thyrotoxic Periodic Paralysis (TPP) is a rare complication of hyperthyroidism characterised by hypokalaemia and recurrent episodes of muscle weakness. Increased awareness will promote early diagnosis and prompt treatment of the condition. Objective: To highlight an uncommon case of TPP in a Nigerian male with normokalaemia on presentation. Case: A 20-year-old male patient on treatment for hyperthyroidism (Grave’s disease) who was referred to the endocrine clinic on account of recurrent episodes of acute symmetrical painful lower limb muscle weakness. He had experienced a total of 5 episodes approximately 2-3 months apart with each attack lasting between 10-36 h there was a positive history of strenuous activities preceding each attack. Limb pain was relieved by analgesics and weakness resolved spontaneously without any specific medications after 2-3 days. Investigations revealed elevated T3 and T4 (212.3 ng/ml and 18.3 μg/ml respectively), reduced TSH (<0.1 mIU/ ml), low-normal serum potassium (3.6 mmol/L) on presentation and hypokalaemia (2.5 mmol/L) during an episode and hypocalcaemia (2.0 mmol/L). He was placed on 30 mg of carbimazole, propranolol 120 mg in divided doses and low dose oral potassium chloride. He showed remarkable response to treatment with reduction in the frequency of attacks and eventual resolution of symptoms.

The clinical and genetic features in a cohort of mainland Chinese patients with thyrotoxic periodic paralysis.

BackgroundThyrotoxic periodic paralysis (TPP) is a life-threatening channelopathy manifesting as recurrent episodes of hypokalemia and muscle weakness in the presence of hyperthyroidism. Recent findings indicate defects of inward rectifying K+ (Kir) channels are associated with some TPP patients. The associations are not only found in Caucasian population (mainly Brazilian), but also in Singaporean population. However, potential genetic risk factors for mainland Chinese patients, the largest group of TPP cases in the world, have been largely unexplored.MethodsSamples of DNA from 127 individuals with TPP and 102 hyperthyroidism male controls self-reported as mainland Chinese were collected from 5 clinical centers from Jan 2011 to Jan 2014. The KCNJ2 gene, KCNJ18 gene, as well as loci polymorphisms (rs623011and rs312691) at 17q24.3 were directly sequenced in TPP patients and controls. Clinical data were summarized from TPP participants for genotype/phenotype correlations.Results3.1% of TPP cases harbored KCNJ18 gene mutations in mainland Chinese patients. Patients with KCNJ18 mutation had shorter attack duration, higher prevalence of muscle soreness and weakness recurrence than patients without KCNJ18 mutation. The alleles at 17q24.3 (rs623011and rs312691) were more common in patients with TPP than in controls, and therefore were significant risk factors for TPP (odds ratio, 11.94 and 10.57; 95% CI, 5.93-24.05 and 5.48-20.40; P = 1.81 × 10−14 and 1.07 × 10−14 respectively).ConclusionsThis study demonstrates that the KCNJ18 variants are only responsible for a small proportion of TPP patients in mainland China. There are significant clinical differences between patients with KCNJ18 mutations and patients without KCNJ18 mutations. In addition, the rs623011and rs312691 loci are significantly associated with TPP patients in mainland China, and highlight the Kir2.1 channel as a causative target in TPP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0290-8) contains supplementary material, which is available to authorized users.

Thyrotoxic Periodic Paralysis: A Review of Cases in the Last Decade

ABSTRACT Objective: Thyrotoxic periodic paralysis (TPP) is a rare condition characterized by severe muscle weakness and life-threatening hypokalemia in uncontrolled hyperthyroidism. Given the life-threatening potential of this condition, it is important to better characterize its presentation, management, and likelihood for complications to aid in quicker diagnosis and optimize medical management. Methods: We retrospectively reviewed cases of TPP that occurred at 3 hospitals from 2004 to 2014. Patients included were those presenting with weakness and hypokalemia who were found to have thyrotoxicosis. Results: Nine cases of TPP were identified including 7 Hispanic males and 1 African American male. Six patients developed complications of therapy with rebound hyperkalemia. TPP was the first presentation of thyrotoxicosis for 5 patients. The remaining 4 patients with known hyperthyroidism admitted to several weeks of medication nonadherence prior to their episode of TPP. Conclusion: Our study suggests that TPP may be more common in other ethnicities than previously described, with the majority of our cases occurring in Hispanic males. Physicians should be wary of rebound hyperkalemia as it is a common complication of therapy. Because hypokalemia is related to a transcellular shift and not total body depletion of potassium, supplementation with potassium should be done slowly. Early concurrent treatment with nonselective beta-blockers should be employed, and standardized hospital potassium replacement protocols should be avoided. TPP may be the first sign of thyrotoxicosis. All patients with weakness and hypokalemia should undergo thyroid function testing. Abbreviations: ICD International Classification of Disease ICU intensive care unit TPP thyrotoxic periodic paralysis

A case of thyrotoxic periodic paralysis as initial manifestation of Graves' disease in a 16-year-old Korean adolescent

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, with recurrent muscle paralysis and hypokalemia that are caused by an intracellular shift of potassium. TPP is relatively common in Asian males, but is extremely rare in children and adolescents, even for those of Asian descent. We describe a 16-year-old Korean adolescent presenting with a two-week history of episodic leg weakness in the morning. He showed sinus tachycardia, lower leg weakness, and hypokalemia. Thyroid function test showed hyperthyroidism, and thyroid ultrasonography revealed a diffuse enlarged thyroid with increased vascularity, consistent with Graves' disease. He was treated with β-adrenergic blocker and antithyroid drugs. He has been symptom free for one year, as his hyperthyroidism has been controlled well with antithyroid drugs. TPP should be considered in children and adolescents with acute paralysis of the lower extremities and hypokalemia.

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

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.

Thyrotoxic Periodic Paralysis: Correct Hypokalemia with Caution

BackgroundThyrotoxic periodic paralysis is rare in Caucasian populations, but affects approximately 2% of East Asians with thyrotoxicosis (13% of males, 0.17% of females). The presentation is characterized by abrupt-onset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise. ObjectivesTo raise awareness of this condition through the description of a typical case of thyrotoxic periodic paralysis; to remind readers that, despite intravascular hypokalemia, total body potassium is normal and that correction must be done with caution; to highlight the differences in treatment compared to familial hypokalemic periodic paralysis. Case ReportWe describe the presentation of a 36-year-old Filipino man with a background history of Graves disease. Over-administration of intravenous potassium was narrowly averted in this case. ConclusionIt may be important to check thyroid function in patients presenting with acute paralysis, especially those of Asian origin. In patients with thyrotoxic periodic paralysis, administration of potassium, with cardiac monitoring and a total dose of <50 mmol, limits the dysrhythmia risk. Patients are likely to benefit from the prescription of non-selective beta-blockers until they become euthyroid. In contrast to familial periodic paralysis, regular oral potassium supplementation is ineffective in thyrotoxic periodic paralysis, and acetazolamide precipitates, rather than prevents, attacks.

A Case of Thyrotoxic Periodic Paralysis

Hypokalemic periodic paralysis is an uncommon manifestation of thyrotoxicosis and the condition is most commonly reported in young Asian men. Patient often presents with acute onset symmetrical flaccid muscle paralysis and proximal limb muscles may be more severely involved compared to distal muscles. Thyroid swelling as well as features of thyrotoxicosis may not be overt. A very high index of suspicion is often required for the diagnosis of thyrotoxic periodic paralysis. Treatment of throtoxicosis prevents further episodes of paralysis. We report a case of thyrotoxic periodic paralysis in a young male.Bangladesh Journal of Medical Science Vol. 12 No. 03 July ’13 Page 320-321 DOI: http://dx.doi.org/10.3329/bjms.v12i3.12719

Three cases of thyrotoxic periodic paralysis due to painless thyroiditis

We present three cases of thyrotoxic periodic paralysis (TPP) due to painless thyroiditis presenting as acute quadriparesis. All responded to potassium supplementation and propranolol. TPP may be due to thyrotoxicosis of any etiology, commonly Grave's disease. The absence of clinical signs of thyrotoxicosis can delay diagnosis and treatment. Thyroid function tests should be a routine evaluation in all cases of hypokalemic periodic paralysis.

Thyrotoxic Periodic Paralysis with Graves' Disease Leading to the Discovery of a Hidden Nonclassic 11β Hydroxylase Deficiency

11β hydroxylase deficiency (OHD) is one of the main causes of congenital adrenal hyperplasia. There have been only a few reported cases of nonclassic 11β OHD, a milder form of the disease. It is difficult to detect occult nonclassic 11β OHD because patients present with no or mild symptoms. We herein present a case of thyrotoxic periodic paralysis (TPP) with Graves' disease leading to the discovery of a hidden nonclassic 11β OHD. In this case, increased levels of thyroid hormone seem to have induced symptoms of occult nonclassic 11β OHD and aggravated TPP.

A Case of Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis

&lt;p&gt;Thyrotoxic periodic paralysis is an acute muscle weakness of the limbs associated with hypokalemia. It can occur with any form of thyrotoxicosis. Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to thyroiditis is very rare. We experienced a case of thyrotoxic periodic paralysis associated with transient thyrotoxicosis. A 39-yr-old man was referred to our hospital because of paralysis of upper and lower extremity. The laboratory results were hypokalemia and mild thyrotoxicosis. A thyroid scan with Tc-99m revealed decreased uptake in the thyroid area compatible with destructive thyroiditis. The paralytic attack did not recur after the patient recovered to euthyroid state.&lt;/p&gt;

Paralisia periódica tireotóxica.

Thyrotoxic periodic paralysis (TPP) is characterized by recurrent episodes of muscle weakness and hypokalemia associated with thyroid hyperactivity. Reported predominantly among individuals of Asian descent, TPP is a rare manifestation of hyperthyroidism in western populations. We describe a typical case of TPP in a 33-year-old portuguese male, who presented with acute tetraparesis associated with hypokalemia (K+ 2.6 mEq/L). The patient had a 8-week history of several episodes of paraparesis of variable intensity; these attacks were usually nocturnal, preceded by strenuous exercise and resolved spontaneously after a few hours. The presence of tachycardia, weight loss, and goiter led to the diagnosis of Graves's disease. The correction of the hyperthyroid function with metimazol and propranolol prevented further episodes of muscle weakness. Thyrotoxic periodic paralysis should be considered in the differential diagnosis of acute episodes of motor paralysis in young patients. The maintenance of a euthyroid status is an essential part of management as this prevents the paralytic episodes.

Thyrotoxic hypokalemic periodic paralysis: a rare complication of a common disease

Thyrotoxic periodic paralysis (TPP) is an uncommon but potentially lethal manifestation of hyperthyroidism characterized by muscle paralysis and hypokalemia. We have reported 3 cases of TPP in male patients, which manifested with morning muscle weakness evolved into paralysis. In all patients were found severe hypokalemia, abnormalities on electrocardiogram, and Graves' hyperthyroidism. Intravenous potassium administration led to normalization of potassium levels, and resolution of neurological symptoms. In addition, beta blockers and methimazole were started. Two patients required total thyroidectomy for poor control of hyperthyroidism with antithyroid drug. In patients presenting with periodic paralysis or diffuse muscle weakness thyroid function should be investigated in order to find out the cases secondary to unknown hyperthyroidism and to start an early appropriate combined therapy. The correct management of TPP can prevent serious cardiopulmonary complications.

Complete Heart Block during Potassium Therapy in Thyrotoxic Periodic Paralysis

BackgroundAlthough cardiac dysrhythmia is common in patients with thyrotoxic periodic paralysis (TPP), high-degree atrioventricular (AV) block complicated by cardiogenic shock, even under KCl supplementation, is rarely described. ObjectivesTo present a case of TPP in a patient who developed complete AV block with severe consequences due to paradoxical hypokalemia during KCl therapy. In addition, the management of acute hypokalemia in TPP is reviewed. Case ReportA 41-year-old Chinese man with TPP presented to the Emergency Department with a 2-day history of paralysis in the extremities. He developed complete AV block with cardiogenic shock and respiratory failure, necessitating ventilatory support when plasma K+ level decreased from 1.7mmol/L to 1.3mmol/L during KCl replacement of 30mmol in 2h. The administration of another 60mmol KCl over 3h achieved a plasma K+ level of 2.1mmol/L, resulting in the resolution of AV block and successful weaning. However, rebound hyperkalemia (K+ 5.6mmol/L) upon recovery was evident and uneventfully corrected. ConclusionA paradoxical fall in serum K+ concentration with potentially life-threatening complication is still underappreciated in patients with TPP on KCl supplementation. Early recognition and prompt therapy prevent untoward consequences.

Thyrotoxic Periodic Paralysis Induced by Dexamethasone

Thyrotoxic periodic paralysis (TPP) is a disease characterized by sudden onset and muscle paralysis. It occurs in the setting of hypo kalemia of thyrotoxicosis. Cases of TPP induced by a glucocorticoid such as prednisolone or methylprednisolone have been reported. We report on two patients, each of whom received a dexamethasone injection and subsequently developed TPP. Both patients experienced sudden, flaccid paralysis of both extremities after the injection but recovered completely after receiving a potas sium replacement. Laboratory results revealed thyrotoxicosis. The patients were diagnosed with Graves’ disease and discharged af ter receiving treatment with methimazole and propranolol. This report provides the clinical description of TPP induced by dexa methasone injection. These cases suggest that clinicians must consider the presence of hyperthyroid disease in patients who de velop acute paralysis after treatment with a glucocorticoid, even in the absence thyrotoxic symptoms. Furthermore, physicians should be aware that TPP can occur even in response to dexamethasone used for treatment of thyrotoxic crisis or Graves’ ophthalmopathy. (Endocrinol Metab 27:299-302, 2012)

Life-threatening hypokalemia associated with profound electrocardiographic manifestations in thyrotoxic periodic paralysis

We describe a case of thyrotoxic periodic paralysis (TPP) associated with profound electrocardiographic abnormalities and cardiac arrhythmias along with a brief literature review. A 38-year old Hispanic male presented with a history of intermittent profound lower extremity weakness which went undiagnosed for over a year before a diagnosis of thyrotoxic periodic paralysis (TPP) was made. The patient experienced ventricular tachycardia, as well as complete atrioventricular block and a right bundle branch block requiring urgent treatment. Although all these electrocardiographic abnormalities are known to occur in TPP, they are rarely manifest together in a single patient. TPP is a frequently unrecognized but life-threatening disorder which requires a high index of suspicion for prompt diagnosis and treatment. Our patient demonstrates the multiple electrocardiographic abnormalities associated with TPP and severe hypokalemia. Unfortunately, this condition went unrecognized for over a year, highlighting the need for better recognition of this potentially fatal disorder.

A Rare Case of Thyrotoxic Periodic Paralysis Presenting to the Medical Examiner

Thyrotoxic periodic paralysis is a rare and dramatic complication of hyperthyroidism. Thyrotoxic periodic paralysis classically presents with proximal lower limb weakness in the setting of hypokalemia and thyrotoxicosis. Thyrotoxic periodic paralysis represents an endocrine emergency with a rapidly ascending paralysis that can result in respiratory insufficiency, cardiac arrhythmias, and death if not accurately and rapidly diagnosed. We report a case of undiagnosed fatal thyrotoxic periodic paralysis presenting to the medical examiner. The diagnosis was made primarily by review of the clinical history.