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Acute Paralysis Recovered Within 24 Hours in a Young African American Man: A Case of Thyrotoxic Hypokalemic Periodic Paralysis FREE TO VIEW

Bassam Yaghmour, MD; Ivan Romero-Legro, MD; Muthiah Muthiah, MD; Amado X Freire, MD
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University of Tennessee Health Science Center College of Medicine, Memphis, TN

Chest. 2014;146(4_MeetingAbstracts):249A. doi:10.1378/chest.1991988
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SESSION TITLE: Critical Care Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a case of young African American patient presented with acute onset of generalized paralysis, and profound hypokalemia; with clinical and laboratory features consistent with thyrotoxicosis.

CASE PRESENTATION: ​A 24-year-old African American man presented with one day history of new onset generalized paralysis, associated with one-week history of palpitation, tremor, weight loss, and increased appetite. He had no fever, chills, neck pain, or headache. On examination patient was afebrile, normotensive, and tachycardic. Neurological exam was significant for diffuse proximal 1/5 upper and lower extremities weakness with decreased DTR. Sensation and mental status were intact. Laboratory data showed potassium 1.4 mmol, magnesium 1.9 mg/dl, TSH less than 0.015 mcIU, and free T4 3.17 Ng/Dl. These clinical and laboratory features were consistent with THPP. Potassium was replaced carefully and patient was stated on propranolol and methimazol. Within 24 hours of admission patient s symptoms recovered. He was diagnosed with Graves disease and had thyroid ablation on the day of discharge.

DISCUSSION: Thyrotoxic Hypokalemic Periodic Paralysis (THPP) is a rare and devastating complication of thyrotoxicosis, characterized by attacks of acute paralysis, with profound hypokalemia in patients with hyperthyroidism. Clinicians’ unfamiliarity with this uncommon disease is compounded by the relative scarcity of reported cases in the United State as compared with eastern parts of the world. <!--StartFragment-->The pathogenesis is unclear but is thought to be due to an acquired dysfunction of the Na-K-ATPase pump. It is more common in young Asian males than African patients. The presence of profound hypokalemia (mean serum potassium level of 2 mmol/L) and the presence of clinical and biological signs of hyperthyroidism led to the diagnosis. Initial management relies on β-blocker treatment and careful potassium supplementation. Medical or surgical etiological treatment of the thyrotoxicosis is essential to prevent a recurrence.

CONCLUSIONS: Clinician should increse their awareness of THPP, as early recognition is crucial for proper management and prevention of recurrence.

Reference #1: Pothiwala P, et al. Analytic review: thyrotoxic periodic paralysis. J Intensive Care Med. 2010;25(2):71.

Reference #2: Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine. 1992;71(3):109.

Reference #3: Birkhahn RH, et al. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med. 2000;18(2):199.

DISCLOSURE: The following authors have nothing to disclose: Bassam Yaghmour, Ivan Romero-Legro, Muthiah Muthiah, Amado X Freire

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