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VOLUME 22 , ISSUE 5 ( 2018 ) > List of Articles

CASE REPORT

Thyrotoxic hypokalemic periodic paralysis

Satish Kumar, Satyendra Sonkar, Neeraj Singh

Keywords : Hyperthyroidism, hypokalemia, quadriparesis

Citation Information : Kumar S, Sonkar S, Singh N. Thyrotoxic hypokalemic periodic paralysis. Indian J Crit Care Med 2018; 22 (5):378-380.

DOI: 10.4103/ijccm.IJCCM_369_17

License: CC BY-ND 3.0

Published Online: 00-05-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Hypokalemia is a serious and life-threatening clinical condition. We present a case of a 45-year-old male, with known hyperthyroidism presenting with profound tremor, irritability, quadriparesis, and labored breathing since morning, on the day of admission. Arterial blood gas analysis showed severe hypokalemia. Patient\'s vital was stabilized and patient\'s oxygen saturation was maintained on oxygen inhalation. Intravenous potassium chloride infusion was administered with regular monitoring of vitals and electrolytes. Patient\'s symptoms improved. Thyroid function testing showed high free T3 (tri-iodothyronine) and free T4 (thyroxine) with low thyroid-stimulating hormone concentration in the serum, indicating thyrotoxic hypokalemic periodic paralysis. Treatment with antithyroid drug carbimazole resulted in an improvement during the follow-up visit. Hypokalemia is believed to be a consequence of a massive shift due to increased sodium–potassium–adenosine triphosphatase (Na+K+ATPase) pump activity in the presence of elevated thyroid hormones.


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  1. Fontaine B, Vale-Santos J, Jurkat-Rott K, Reboul J, Plassart E, Rime CS, et al. Mapping of the hypokalaemic periodic paralysis (HypoPP) locus to chromosome 1q31-32 in three European families. Nat Genet 1994;6:267-72.
  2. Millikan CH, Haines SF. The thyroid gland in relation to neuromuscular disease. AMA Arch Intern Med 1953;92:5-39.
  3. McFadzean AJ, Yeung R. Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1967;1:451-5.
  4. Lin SH. Thyrotoxic periodic paralysis. Mayo Clin Proc 2005;80:99-105.
  5. Gennari FJ. Hypokalemia. N Engl J Med 1998;339:451-8.
  6. Tassone H, Moulin A, Henderson SO. The pitfalls of potassium replacement in thyrotoxic periodic paralysis: A case report and review of the literature. J Emerg Med 2004;26:157-61.
  7. Shayne P, Hart A. Thyrotoxic periodic paralysis terminated with intravenous propranolol. Ann Emerg Med 1994;24:736-40.
  8. Birkhahn RH, Gaeta TJ, Melniker L. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med 2000;18:199-202.
  9. Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves' disease. Autoimmun Rev 2014;13:398-402.
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