A case of thyrotoxic periodic paralysis

Abstract

A CASE OF THYROTOXIC PERIODIC PARALYSIS Ankit Sakhuja, Pinky Patel, Aaron Dall. Medical College of Wisconsin, Milwaukee, WI, USA Thyrotoxic periodic paralysis is an uncommon disease affecting mostly young Asian males. It is usually associated with hyperthyroidism, mostly Grave’s disease. We present a case of thyrotoxic periodic paralysis in a young African American male with no significant past medical history. A 19 year old African American male with no significant past medical history presented to the emergency room with a history of significant weakness. He went to bed the night prior without any problems after a family dinner. He was however unable to get out of bed next morning and had to crawl out of bed. He denied any fever, diarrhea, URI, sick contacts, recent travel and insect or tick bites. His physical examination was significant for proximal muscle weakness more in lower extremities. Labs were significant for potassium of 2.6. meq/L, TSH 0.011 μIU/mL and fT4 2.71 ng/dL. His EKG showed U waves. Patient was diagnosed with thyrotoxic periodic paralysis, given 20 meq of potassium chloride and monitored in the hospital. His strength and potassium levels normalized within 24 hours. He was also started on propranolol and a thyroid scan confirmed Grave’s disease. Thyrotoxic periodic paralysis is an uncommon condition associated with hyperthyroidism. It usually presents in early morning and patients have significant hypokalemia on presentation. However the condition is usually self limited and potassium supplementation can lead to dangerous hyperkalemia. Propranolol has been shown to help abort the attack.