Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department
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...
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doaj-f0c535be2ed04029a51c6d3fd968ae3f2020-11-25T03:32:05ZengMDPI AGDiagnostics2075-44182020-05-011031631610.3390/diagnostics10050316Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency DepartmentStefana Bilha0Ovidiu Mitu1Laura Teodoriu2Cristian Haba3Cristina Preda4Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, RomaniaCardiology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, RomaniaEndocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, RomaniaCardiology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, RomaniaEndocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, RomaniaDespite 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.https://www.mdpi.com/2075-4418/10/5/316thyrotoxic periodic paralysishypokalemiaventricular arrhythmiaGraves’ disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stefana Bilha Ovidiu Mitu Laura Teodoriu Cristian Haba Cristina Preda |
spellingShingle |
Stefana Bilha Ovidiu Mitu Laura Teodoriu Cristian Haba Cristina Preda Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department Diagnostics thyrotoxic periodic paralysis hypokalemia ventricular arrhythmia Graves’ disease |
author_facet |
Stefana Bilha Ovidiu Mitu Laura Teodoriu Cristian Haba Cristina Preda |
author_sort |
Stefana Bilha |
title |
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department |
title_short |
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department |
title_full |
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department |
title_fullStr |
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department |
title_full_unstemmed |
Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department |
title_sort |
thyrotoxic periodic paralysis—a misleading challenge in the emergency department |
publisher |
MDPI AG |
series |
Diagnostics |
issn |
2075-4418 |
publishDate |
2020-05-01 |
description |
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. |
topic |
thyrotoxic periodic paralysis hypokalemia ventricular arrhythmia Graves’ disease |
url |
https://www.mdpi.com/2075-4418/10/5/316 |
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