Thyrotoxic Periodic Paralysis

  • Hisham Mohamed Abdelrahim Hisham Mohamed Abdelrahim consultant endocrinologist
  • Amel Kamel M.Saeed Amel Kamel M.Saeed consultant endocrinologest Alneelain University
  • Rasha Elamin Ahmed Elmansor 3. Rasha Elamin Ahmed Elmansor fellowship endocrinology and metabolism Sudan medical specialization board.

Abstract

Periodic paralysis (PP) is a muscle disease in the family of diseases called channelopathies, manifested by episodes of painless muscle weakness. PP is classified as hypokalemic or hyperkalemic according to level of potassium (K⁺). Most cases of PP are hereditary, but acquired cases of hypokalemic PP have been described in association with hyperthyroidism. We report a case of 48 years old female who presented to ER with one day history of sudden onset of bilateral lower limbs weakness. She gave history of transient episode of bilateral leg weakness one week earlier, recovered spontaneously. She is known case of DM for eight years but has no family history of muscle disorders. Her examination at time of presentation, showed – in addition to the lower limbs weakness-clinical features of thyrotoxicosis. According to her clinical presentation, laboratory findings and the evident data of known association of hypokalemic periodic paralysis (PP) and thyrotoxicosis, the patient was diagnosed as hyperthyroidism with hypokalemic periodic paralysis. The patient responded very well to emergency management of hypokalemia as well as the treatment of thytotoxicosis. Thyrotoxic periodic paralysis (TPP) is a rare but potentially serious complication of thyrotoxicosis resulting in temporary but severe muscle weakness, Prompt recognition of the problem allows for proper short- and long-term management of this condition.

References

1. Oxford Textbook of Endocrinology and Diabetes Part 3 The thyroid Thyrotoxicosis and related disorders 3.3.2 Thyrotoxic periodic paralysis
2. Y. J. Hsu, Y. F. Lin, T. Chau, J. T. Liou, S. W. Kuo, and S. H. Lin, “Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis,” The American Journal of the Medical Sciences, vol. 326, no. 3, pp. 128–132, 2003. View at Publisher • View at Google Scholar • View at Scopus
3. Lee KO, Taylor EA, Oh VMS, Cheah JS, Aw SE. Hyperinsulinaemia in thyrotoxic hypokalaemic periodic paralysis. Lancet, 1991; 337: 1063–[CrossRef] [Web of Science] [Medline] [OpenURL]
4. Fraser CL, Sarnacki P. Na+-K+-ATPase pump function in rat brain synaptosomes is different in males and females. Am J Physiol , 1989; 257:E284 –9. [Web of Science] [Medline]
5 . D. P. Ryan, M. R. Dias da Silva, T. W. Soong et al., “Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis,” Cell, vol. 140, no. 1, pp. 88–98, 2010. View at Publisher • View at Google Scholar • View at PubMed • View at Scopus 6. Crane MG. Periodic paralysis associated with hyperthyroidism. Calif Med , 1960; 92: 285–8. [Medline] [OpenURL] 12
7. Yeo PPB, Lee KO, Cheah JS. Hyperthyroidism and periodic paralysis. In: Imura H, Shizume K, Yoshida S, eds. Progress in Endocrinology. Vol 2. Amsterdam: Excerpta Medica, 1988:1341 –6
8. 1 Kelley DE, Gharib H, Kennedy FP, Duda RJ Jr, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Intern Med 1989;149:2597–2600. [PubMed] [Google Scholar]
9. C. Boccalandro, L. Lopez, F. Boccalandro, and V. Lavis, “Electrocardiographic changes in thyrotoxic periodic paralysis,” The American Journal of Cardiology, vol. 91, no. 6, pp. 775–777, 2003. View at Publisher • View at Google Scholar • View at Scopus
10 .Y. Miyashita, T. Monden, K. Yamamoto et al., “Ventricular fibrillation due to severe hypokalemia induced by steroid treatment in a patient with thyrotoxic periodic paralysis,” Internal Medicine, vol. 45, no. 1, pp. 11–13, 2006. View at Publisher • View at Google Scholar • View at Scopus
11. Kung AW. Clinical review: Thyrotoxic periodic paralysis: A diagnostic challenge. J Clin Endocrinol Metab. 2006;91:2490–5. [PubMed] [Google Scholar] 13
12. Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis. 2001;37:620–3. [PubMed] [Google Scholar]
Published
2019-12-31
How to Cite
ABDELRAHIM, Hisham Mohamed; M.SAEED, Amel Kamel; ELMANSOR, Rasha Elamin Ahmed. Thyrotoxic Periodic Paralysis. Gezira Journal of Health Sciences, [S.l.], v. 15, n. 2, dec. 2019. ISSN 1810-5386. Available at: <http://journals.uofg.edu.sd/index.php/gjhs/article/view/1412>. Date accessed: 06 june 2020.
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Articles