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Rare case of thyrotoxic Periodic Paralysis reported in NEJM
Researchers, Michael Fralick and Shohinee Sarma from the University of Toronto, Toronto, ON, Canada have recently documented an interesting case report of thyrotoxic periodic paralysis. The case is published in the New England Journal of Medicine. Thyrotoxic periodic paralysis is a condition that is characterized by episodes of muscle weakness associated...
Researchers, Michael Fralick and Shohinee Sarma from the University of Toronto, Toronto, ON, Canada have recently documented an interesting case report of thyrotoxic periodic paralysis.
The case is published in the New England Journal of Medicine.
Thyrotoxic periodic paralysis is a condition that is characterized by episodes of muscle weakness associated with hyperthyroidism.
The authors studied the case of a 25-year-old man who presented to the emergency department with a sudden onset of weakness in his arms and legs. He reported a 3-month history of intermittent arm and leg weakness, palpitations, trembling, and insomnia.
On a thorough examination, he had a heart rate of 107 beats per minute, a palpable goiter, and an inability to lift his arms or legs. Laboratory studies were advised which revealed a potassium level of 1.6 mmol per liter (reference range, 3.5 to 5.0), a phosphate level of 0.5 mmol per liter (reference range, 0.8 to 1.5), a thyrotropin level of less than 0.01 μU per milliliter (reference range, 0.40 to 3.80), a free triiodothyronine level of 2.21 ng per deciliter (reference range, 0.26 to 0.44), and a free thyroxine level of 7.8 ng per deciliter (reference range, 0.9 to 1.6).
Furthermore, supplementation with potassium and phosphate was initiated. When the potassium level had increased to 1.9 mmol per liter, he was able to lift his arms but was still unable to lift his legs.
However, when the potassium level was 3.3 mmol per liter (approximately 4 hours after the initial examination), he was able to fully lift his arms and legs.
Therefore, the researchers confirmed a diagnosis of thyrotoxic periodic paralysis. The episodes usually are typically associated with severe hypokalemia.
The treatment with methimazole and propranolol was then initiated. At follow-up 3 weeks later, he reported no arm or leg weakness, palpitations, trembling, or insomnia.
The authors laid out the laboratory tests which further revealed elevated levels of thyrotropin-receptor antibodies (>40 IU per liter [reference value, <1.0]), thereby confirming a diagnosis of Graves' disease.
For further reference, log in to:
Thyrotoxic Periodic Paralysis. N. Engl. J. Med 2021 May 13;384(19)e71, M Fralick, S Sarma
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751