Thyrotoxic Periodic Paralysis due to Graves' disease: a mandatory differential diagnosis in Asian patients presenting with paralysis and hypokalemia

2017 ◽  
Author(s):  
David Barbosa ◽  
Carolina Faria ◽  
Ana Sofia Osorio ◽  
Ema Nobre ◽  
Ana Paula Vilas ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Patients

scholarly journals Rhabdomyolysis Induced by Nonstrenuous Exercise in a Patient with Graves’ Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Sarawut Summachiwakij ◽  
Issac Sachmechi
Keyword(s):  
Differential Diagnosis ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Past Medical History ◽  
Thyrotoxic Periodic Paralysis ◽  
Radioiodine Uptake ◽  
Thyroid Stimulating Immunoglobulins ◽  
History Of ◽  
Brown Urine ◽  
Thyroid Ophthalmopathy

Hyperthyroidism can result in several musculoskeletal conditions such as thyrotoxic periodic paralysis, thyrotoxic myopathy, and thyroid ophthalmopathy. Rhabdomyolysis has been rarely reported to be associated with hyperthyroidism. We describe a 33-year-old man who presented with bilateral thigh pain and dark brown urine after regular squatting. He had a past medical history of hyperthyroidism but stopped taking it 2 months prior to admission. He was found to have rhabdomyolysis, myoglobinuria, and thyrotoxicosis. Presence of thyroid-stimulating immunoglobulins (TSI) and high radioiodine uptake confirmed a diagnosis of Graves' disease. He received aggressive fluid resuscitation and sodium bicarbonate intravenously along with monitoring fluid and electrolyte. Methimazole was also resumed. The patient responded to treatment and rhabdomyolysis gradually resolved. Therefore, nonstrenuous exercise can potentially induce rhabdomyolysis in patients with hyperthyroidism. Although hyperthyroidism is not widely recognized as a cause of rhabdomyolysis, it should be considered in the differential diagnosis of rhabdomyolysis.

scholarly journals THYROTOXIC PERIODIC PARALYSIS IN A PATIENT WITH GRAVES DISEASE AND WOLF PARKINSON WHITE SYNDROME

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A245
Author(s):  
Brenda Nyatanga ◽  
Bryan Stringer ◽  
Srinivas Nadadur
Keyword(s):  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
White Syndrome

scholarly journals Thyrotoxic Periodic Paralysis and Cardiomyopathy in a Patient with Graves’ Disease

Cureus ◽  
2018 ◽  
Author(s):  
Anna A Abbasi ◽  
Prarthna Chandar ◽  
Shyam Shankar ◽  
Sushilkumar S Gupta ◽  
Yizhak Kupfer
Keyword(s):  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis

scholarly journals A Case of Nonfatal Ventricular Arrhythmia Due to Thyrotoxic Periodic Paralysis in a Saudi Patient as an Initial Presentation of Graves’ Disease

2016 ◽  
Vol 9 ◽  
pp. CCRep.S34560 ◽  
Author(s):  
Osamah Hakami ◽  
Maswood M. Ahmad ◽  
Naji Al Johani
Keyword(s):  
Muscle Weakness ◽  
Early Recognition ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Populations ◽  
Definitive Therapy ◽  
Life Threatening ◽  
Acute Paraparesis ◽  
Saudi Male

Thyrotoxic periodic paralysis (TPP) is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. It has been commonly reported in non-Asian populations. Four cases were reported in Saudis so far, and one had a life-threatening arrhythmia. We describe an additional case of a 28-year-old apparently healthy Saudi male patient, who presented with acute paraparesis associated with hypokalemia (K: 2.0 mmol/L), complicated by ventricular tachycardia and cardiac arrest. He was successfully resuscitated and his hypokalemia was corrected. A diagnosis of Graves’ disease associated with TPP was made. He was initially treated with carbimazole and β-blockers and then given a definitive therapy with radioactive iodine, which showed a good response. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness. A brief review of TPP and associated arrhythmia is included.

scholarly journals Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease

2016 ◽  
Vol 31 (1) ◽  
pp. 142 ◽  
Author(s):  
Suyeon Park ◽  
Tae Yong Kim ◽  
Soyoung Sim ◽  
Seonhee Lim ◽  
Mijin Kim ◽  
...  
Keyword(s):  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis

scholarly journals Contribution of Asian Haplotype of KCNJ18 to Susceptibility to and Ethnic Differences in Thyrotoxic Periodic Paralysis

2019 ◽  
Vol 104 (12) ◽  
pp. 6338-6344
Author(s):  
Shinsuke Noso ◽  
Naru Babaya ◽  
Yoshihisa Hiromine ◽  
Hiroyuki Ito ◽  
Yasunori Taketomo ◽  
...  
Keyword(s):  
Direct Sequencing ◽  
East Asian ◽  
Japanese Patients ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Strong Linkage Disequilibrium ◽  
Single Nucleotide Variants ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Populations ◽  
Haplotype 1

Abstract Context and Objectives Thyrotoxic periodic paralysis (TPP) is an acute complication of thyrotoxicosis that can be lethal. TPP is rare in Caucasians but often affects young men in East Asian populations. This study aimed to clarify the contribution of KCNJ18 to susceptibility to TPP in East Asian populations. Participants and Methods The study comprised 635 participants including 13 Japanese patients with TPP, 208 Japanese patients with Graves disease without TPP, and 414 healthy control subjects from the Japanese (n = 208), Korean (n = 111), and Caucasian populations (n = 95). DNA samples from 29 participants (13 with TPP, 8 with Graves disease, and 8 controls) were sequenced for KCNJ18, and all participants (n = 635) were genotyped for six variants of KCNJ18 and a polymorphism of KCNJ2 (rs312691). Results Six single-nucleotide variants (SNVs) with amino acid substitutions were identified by direct sequencing of KCNJ18. Among these, four SNVs comprised three haplotypes under strong linkage disequilibrium. Haplotype 1 (AAAG) of KCNJ18 was significantly associated with susceptibility to TPP in the Japanese population (OR = 19.6; 95% CI, 1.5 to 256.9; P = 0.013). Haplotype frequencies in the general East Asian (Japanese and Korean) and Caucasian populations differed significantly (haplotype 1: 80.8% vs 48.4%, P = 1.1×10−27). Conclusion A major haplotype of KCNJ18 in East Asian populations is significantly associated with susceptibility to TPP. The haplotype is much more common in East Asian than Caucasian populations, suggesting its contribution to the high prevalence of TPP in East Asian populations.

scholarly journals Bilateral Lower Extremity Paralysis in a Caucasian Male Presenting to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Yicheng K. Bao ◽  
Vishwanath C. Ganesan ◽  
Richard Rapp ◽  
Shunzhong S. Bao
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Lower Extremity ◽  
Lumbar Puncture ◽  
Emergency Physician ◽  
Sudden Onset ◽  
Periodic Paralysis ◽  
Thyrotoxic Periodic Paralysis ◽  
Bilateral Lower Extremity ◽  
Negative Results

Reported is a case of a 39-year-old Caucasian man who presented to the emergency department with sudden onset bilateral lower extremity paralysis after consuming a large amount of carbohydrates and alcohol. A CT, MRI, and lumbar puncture were performed with negative results; lab results showed hyperthyroidism and hypokalemia. The patient was diagnosed with thyrotoxic periodic paralysis. In a patient presenting with sudden onset paralysis and hypokalemia, the emergency physician should include thyrotoxic periodic paralysis in the differential diagnosis and focus on treating and working up the hypokalemia instead of the paralysis.

scholarly journals Thyrotoxic Periodic Paralysis: A Rare Presentation of Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A966-A967
Author(s):  
Bishow Chandra Shrestha ◽  
Chheki Sherpa ◽  
Swarup sharma Rijal ◽  
Vasudev Magaji ◽  
Vinita Singh
Keyword(s):  
Asian Population ◽  
Periodic Paralysis ◽  
Flaccid Paralysis ◽  
Definitive Treatment ◽  
Muscle Membrane ◽  
Graves Disease ◽  
Low Grade ◽  
Thyrotoxic Periodic Paralysis ◽  
Potassium Replacement ◽  
Hyperthyroid Patients

Abstract Background: Thyrotoxic periodic paralysis (TPP) is a rare but serious thyroid emergency characterized by hypokalemia, acute onset flaccid paralysis & thyrotoxicosis. Typically, seen in an Asian male with untreated hyperthyroidism symptoms, who awakens at night or in the early morning with flaccid ascending paralysis. This is precipitated by exercise, alcohol or carbohydrate rich meal. TPP is widely reported & studied in Asian population. Its prevalence is about 2 % in Asian hyperthyroid patients. However, incidence is 0.1-0.2% in non-Asian hyperthyroid patients. Clinical Case: 33-year-old Caucasian male with celiac disease and no thyroid disease sought emergency care for complaints of sudden onset severe weakness in all extremities. He reported 20-pound unintentional weight loss, intermittent palpitations and low-grade fever. He noticed leg cramps with numbness and unable to move his extremities. At initial evaluation, he had acute flaccid paralysis and tachycardia. Initial laboratory studies showed potassium at 1.9 mmol/l, Magnesium at 1.8, suppressed TSH <0.005 uIU/ml with elevations in free T4 at 2.43 ng/dl and total T3 at 1.9 ng/ml. CT and MRI head were normal. Patient’s aldosterone level was normal. The patient’s paralysis and hypokalemia resolved after potassium replacement. Thyroid stimulating immunoglobulin was elevated and increased vascularity suggestive of Grave’s disease noted on thyroid Ultrasound. Methimazole and propranolol were initiated. His neurological workup was negative. After resolution of paralysis and hypokalemia he was discharged home. Since our patient presented with severe hypokalemia, flaccid paralysis and hyperthyroidism, that resolved promptly with potassium replacement, hence likely diagnosis of thyrotoxic periodic paralysis. Discussion: Thyrotoxic periodic paralysis is potentially reversible and mostly seen with Graves’ disease among Asian population. Early diagnosis & treatment prevents life threatening complications. Differential diagnosis of TPP includes familial periodic paralysis, Guillain-Barre Syndrome & acute intermittent porphyria. Diagnosis is based on family history, characteristic presentation, hyperthyroidism with low serum potassium level. Possible mechanism is increased sodium-potassium ATPase activity in the skeletal muscle membrane leading to intracellular shift of potassium causing hypokalemia and muscle inexcitability. Treatment includes potassium replacement, nonselective beta-blocker and definitive treatment of hyperthyroidism, to prevent further episodes.

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