scholarly journals Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 316 ◽  
Author(s):  
Stefana Bilha ◽  
Ovidiu Mitu ◽  
Laura Teodoriu ◽  
Cristian Haba ◽  
Cristina Preda
Keyword(s):  
Clinical Signs ◽  
Initial Therapy ◽  
Periodic Paralysis ◽  
The Other ◽  
Motor Deficit ◽  
Antithyroid Drugs ◽  
Thyrotoxic Periodic Paralysis ◽  
First Case ◽  
Life Threatening ◽  
Antithyroid Agents

Despite its’ life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series of three cases of TPP as first presentation of Graves’ disease in a young Caucasian male and in two Caucasian elderly and middle-aged women, respectively. The first patient developed malignant ventricular arrhythmias due to severe hypokalemia and was defibrillated, with recovery after prompt potassium correction and administration of antithyroid agents and propranolol. The other two cases developed persistent hypokalemia despite adequate potassium chloride (KCl) repletion, with slow recovery of motor deficit and serum potassium normalization up to day 5. In the first case, long-term euthyroid state was achieved via total thyroidectomy due to the presence of a suspicious nodule that proved to be malignant. In the other two cases, medical treatment was the choice of therapy for thyrotoxicosis. None experienced recurrent TPP. Thyroid hormone evaluation is mandatory in the presence of hypokalemic paralysis, even in the absence of clinical signs of thyrotoxicosis. If TPP is confirmed, initial therapy should comprise antithyroid drugs and propranolol, besides hypokalemia correction.

scholarly journals Evaluating the Efficacy of Primary Treatment for Graves’ Disease Complicated by Thyrotoxic Periodic Paralysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Rita Yuk-Kwan Chang ◽  
Brian Hung-Hin Lang ◽  
Ai Chen Chan ◽  
Kai Pun Wong
Keyword(s):  
Radioactive Iodine ◽  
Primary Treatment ◽  
Periodic Paralysis ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Term Efficacy ◽  
Life Threatening ◽  
Life Threatening Complication

Objective. Thyrotoxic periodic paralysis (TPP) is a potentially life-threatening complication of Graves’ disease (GD). The present study compared the long-term efficacy of antithyroid drugs (ATD), radioactive iodine (RAI), and surgery in GD/TPP.Methods. Sixteen patients with GD/TPP were followed over a 14-year period. ATD was generally prescribed upfront for 12–18 months before RAI or surgery was considered. Outcomes such as thyrotoxic or TPP relapses were compared between the three modalities.Results. Eight (50.0%) patients had ATD alone, 4 (25.0%) had RAI, and 4 (25.0%) had surgery as primary treatment. Despite being able to withdraw ATD in all 8 patients for 37.5 (22–247) months, all subsequently developed thyrotoxic relapses and 4 (50.0%) had ≥1 TPP relapses. Of the four patients who had RAI, two (50%) developed thyrotoxic relapse after 12 and 29 months, respectively, and two (50.0%) became hypothyroid. The median required RAI dose to render hypothyroidism was 550 (350–700) MBq. Of the 4 patients who underwent surgery, none developed relapses but all became hypothyroid.Conclusion. To minimize future relapses, more definitive primary treatment such as RAI or surgery is preferred over ATD alone. If RAI is chosen over surgery, a higher dose (>550 MBq) is recommended.

scholarly journals Acute upper airway obstruction as a life-threatening complication of ventral bulla osteotomy: report of two consecutive cases

2021 ◽  
Vol 7 (1) ◽  
pp. 205511692110059
Author(s):  
Michal Vlasin ◽  
Richard Artingstall ◽  
Barbora Mala
Keyword(s):  
Airway Obstruction ◽  
Clinical Signs ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Single Session ◽  
Inflammatory Polyp ◽  
Case Summary ◽  
First Case ◽  
Life Threatening

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

scholarly journals Thyrotoxic Periodic Paralysis Causing Back Pain and Leg Weakness: An Unusual Presentation of Hyperthyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Henrik Elenius ◽  
Marie Cesa ◽  
Corina C. Nava Suarez ◽  
Abhishek Nimkar ◽  
Prasanta Basak ◽  
...  
Keyword(s):  
Muscle Weakness ◽  
Periodic Paralysis ◽  
Close Monitoring ◽  
Respiratory Compromise ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Populations ◽  
Life Threatening ◽  
Common Etiology ◽  
Leg Weakness ◽  
Hispanic Male

Thyrotoxic periodic paralysis (TPP) is a rare muscular disorder, characterized by muscle weakness and hypokalemia triggered by thyrotoxicosis. In Asian populations, 2% of patients with thyrotoxicosis are affected, compared to only 0.1–0.2% of non-Asians. The vast majority of patients are male. Muscle weakness ranges in severity from very mild to life-threatening, due to respiratory compromise. We present a case of a previously healthy 39-year-old Hispanic male who presented with sudden quadriparesis and quickly recovered after being treated for hypokalemia and thyrotoxicosis. TPP, although unusual, is important to recognize as it is a potentially fatal condition that requires close monitoring and is readily reversible with appropriate therapy. Any cause of thyroid hormone excess can cause TPP, with Graves’ disease being the most common etiology. Acute treatment includes potassium repletion, while long-term management focuses on determining and treating the cause of thyrotoxicosis, since maintaining a euthyroid state will prevent further episodes of TPP.

scholarly journals A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants

2013 ◽  
Vol 169 (5) ◽  
pp. 529-536 ◽  
Author(s):  
Chin-Chun Chang ◽  
Chih-Jen Cheng ◽  
Chih-Chien Sung ◽  
Tzong-Shi Chiueh ◽  
Chien-Hsing Lee ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Periodic Paralysis ◽  
Strenuous Exercise ◽  
Oral Glucose ◽  
Upper Respiratory Tract ◽  
Precipitating Factors ◽  
Loading Test ◽  
Thyrotoxic Periodic Paralysis

BackgroundA comprehensive analysis has not been performed on patients with thyrotoxic periodic paralysis (TPP) characterized by acute hypokalemia and paralysis in the setting of thyrotoxicosis.PurposeThe aim of this study was to analyze the detailed symptomatology of thyrotoxicosis and precipitating factors for the attack in a large cohort of TPP patients.Patients and methodsA prospective observational study enrolled patients with TPP consecutively over 10 years at an academic medical center. Clinical features, including signs/symptoms of thyrotoxicosis and precipitating factors, were analyzed. The Wayne's index was used to assess the severity of thyrotoxicosis at presentation. Patients who agreed to receive an oral glucose-loading test after recovery were evaluated.ResultsAmong the 135 TPP patients (male:female, 130:5), 70% of paralytic attacks occurred in the morning, especially during the seasons of summer and fall. Two-thirds of patients did not have a known family or personal history of hyperthyroidism. Only 17% of TPP patients manifested overt signs/symptoms of thyrotoxicosis (Wayne's index >19). A clear precipitating factor, such as high carbohydrate load, acute upper respiratory tract infection, strenuous exercise, high-salt diet, or the use of steroids or bronchodilators, was identified in only 34% of TPP patients. A glucose load to stimulate insulin secretion induced acute hypokalemia (K+2.47±0.6 mmol/l) with reparalysis in only 18% (10/55) of TPP patients.ConclusionsMost TPP patients have only subtle clinical signs/symptoms of thyrotoxicosis and only a small fraction has clear precipitating factors. In addition to the effects of hyperinsulinemia, other insulin-independent mechanisms may participate in the pathogenesis of TPP.

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.

Disorders of potassium homeostasis

2020 ◽  
pp. 4748-4763
Author(s):  
John D. Firth
Keyword(s):  
Serum Potassium ◽  
Potassium Concentration ◽  
Periodic Paralysis ◽  
Electrolyte Disorders ◽  
Thyrotoxic Periodic Paralysis ◽  
Serum Potassium Concentration ◽  
Intravenous Insulin ◽  
Nebulized Salbutamol ◽  
Life Threatening ◽  
Electrocardiogram Ecg

Hypokalaemia is defined as a serum potassium concentration lower than 3.5 mmol/litre and is the most common electrolyte abnormality seen in clinical practice, found in about 20% of hospital inpatients. Clinical features and investigation—mild hypokalaemia is asymptomatic, but nonspecific symptoms develop with more severe disturbance, and serious neuromuscular problems sometimes arise at serum potassium concentrations lower than 2.5 mmol/litre. Emergency management is rarely required, but intravenous infusion of potassium should be given in the rare circumstances of life-threatening cardiac arrhythmia or muscular paralysis. There are a very large number of possible causes of hypokalaemia, the most common causes being diuretics (particularly thiazides), vomiting, and diarrhoea. The most common genetic cause is Gitelman’s syndrome. Management is with potassium and magnesium supplements. Other causes of tubular wasting of potassium include Bartter’s syndrome and mineralocorticoid excess. There are several rare conditions in which hypokalaemia is associated with episodes of extreme weakness/paralysis, including thyrotoxic periodic paralysis and familial hypokalaemic periodic paralysis. Hyperkalaemia, defined as a serum potassium concentration of greater than 5.0 mmol/litre, is asymptomatic, and severe hyperkalaemia (>7 mmol/litre) is the most serious of all electrolyte disorders because it can cause cardiac arrest. The electrocardiogram (ECG) is the best guide to the significance of hyperkalaemia in any particular individual. Patients with ECG manifestations more severe than tenting of the T waves should be given intravenous calcium gluconate (10 ml of 10%) followed by intravenous insulin and glucose, or nebulized salbutamol. There are many causes of hyperkalaemia, but by far the most common are renal failure and/or drugs. Other causes include exhaustive exercise, acidosis, drugs, and hyperkalaemic periodic paralysis (very rare).

scholarly journals Andersen-Tawil Syndrome Presenting with Complete Heart Block

2021 ◽  
Vol 8 (1) ◽  
pp. 151-154
Author(s):  
Karen Suetterlin ◽  
Roope Männikkö ◽  
Enrico Flossmann ◽  
Richa Sud ◽  
Doreen Fialho ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Autosomal Dominant ◽  
Clinical Presentation ◽  
Neuromuscular Disorder ◽  
Periodic Paralysis ◽  
Cardiac Conduction ◽  
Diagnostic Challenge ◽  
Dysmorphic Features ◽  
First Case ◽  
Life Threatening

Andersen-Tawil syndrome (ATS) is a rare autosomal dominant neuromuscular disorder due to mutations in the KCNJ2 gene. The classical phenotype of ATS consists of a triad of periodic paralysis, cardiac conduction abnormalities and dysmorphic features. Episodes of either muscle weakness or cardiac arrhythmia may predominate however, and dysmorphic features may be subtle, masking the true breadth of the clinical presentation, and posing a diagnostic challenge. The severity of cardiac involvement varies but includes reports of life-threatening events or sudden cardiac death, usually attributed to ventricular tachyarrhythmias. We report the first case of advanced atrioventricular (AV) block in ATS and highlight clinical factors that may delay diagnosis.

scholarly journals Upper extremity deep venous thrombosis secondary to thyrotoxic periodic paralysis with accompanying hyperphosphatemia and severe hypomagnesemia

2021 ◽  
Vol 9 (41) ◽  
pp. 47-49
Author(s):  
Jasmin Rahesh ◽  
Layan Al-Sukhni ◽  
Baseer Quraishi ◽  
Tarek Naguib
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Periodic Paralysis ◽  
Central Catheter ◽  
Thyrotoxic Periodic Paralysis ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
Characteristic Features ◽  
Deep Vein

Thyrotoxic periodic paralysis is a rare but life-threatening complication of hyperthyroidism. Characteristic features involve thyrotoxicosis, acute paralysis, and hypokalemia. Mild hypomagnesemia and hypophosphatemia are also present in most cases due to the resulting transcellular shift of electrolytes. Complications of thyrotoxic periodic paralysis reported in the literature have included cerebral venous thrombosis as well as lower extremity deep venous thrombosis. We present a patient with an unusual presentation of thyrotoxic periodic paralysis as reflected by hyperphosphatemia, upper extremity deep venous thrombosis and severe hypomagnesemia. This is the first reported case of upper extremity deep vein thrombosis in association with a peripherally inserted central catheter line secondary to thyrotoxicosis.

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