Thyrotoxic periodic paralysis as an initial presentation of Graves' disease in a Saudi patient

BMJ Case Rep. 2017 Jun 19:2017:bcr2017220224. doi: 10.1136/bcr-2017-220224.

Abstract

Thyrotoxic periodic paralysis (TPP) is a well-known complication of hyperthyroidism, characterised by recurrent flaccid paralysis with hypokalaemia. To date, only five cases of this rare disorder have been reported in Saudi Arabia. Here, we report an additional case involving a 25-year-old Saudi man who presented with lower limb paralysis and severe hypokalaemia. Clinically, he showed symptoms and signs suggestive of Graves' disease, which was confirmed by laboratory investigations. Carbimazole, a beta-blocker and potassium replacement were administered, resulting in dramatic improvement of the TTP. This case emphasises the importance of considering TPP in patients with acute muscle weakness and the importance of promptly initiating treatment and preventing relapse of TPP.

Keywords: disturbances; endocrinology; fluid electrolyte and acid-base; muscle; thyroid disease.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Antithyroid Agents / administration & dosage
  • Antithyroid Agents / therapeutic use*
  • Carbimazole / administration & dosage
  • Carbimazole / therapeutic use*
  • Diagnosis, Differential
  • Graves Disease / complications*
  • Graves Disease / drug therapy
  • Humans
  • Hyperthyroidism / complications*
  • Hyperthyroidism / drug therapy
  • Hypokalemia / diagnosis
  • Hypokalemia / drug therapy
  • Hypokalemia / etiology
  • Lower Extremity / pathology
  • Male
  • Muscle Weakness / diagnosis
  • Muscle Weakness / drug therapy*
  • Muscle Weakness / etiology
  • Paralysis / diagnosis*
  • Paralysis / etiology
  • Potassium / therapeutic use
  • Rare Diseases
  • Saudi Arabia / epidemiology
  • Thyrotoxicosis / complications*
  • Thyrotoxicosis / drug therapy
  • Treatment Outcome

Substances

  • Adrenergic beta-Antagonists
  • Antithyroid Agents
  • Carbimazole
  • Potassium