Hypokalemic thyrotoxic periodic paralysis. Report of one case

León, José; Muñoz, Neus; Rivero, Angel

doi:10.1016/j.medcle.2018.07.024

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Report of one case" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "372" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José León, Neus Muñoz, Angel Rivero" "autores" => array:3 [ 0 => array:3 [ "nombre" => "José" "apellidos" => "León" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Neus" "apellidos" => "Muñoz" "email" => array:1 [ 0 => "neus85@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Angel" "apellidos" => "Rivero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Endocrinología y Nutrición, Hospital Corporació Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital Corporació Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parálisis periódica hipopotasémica tirotóxica, a propósito de un caso" ] ] "textoCompleto" => "Hypokalemic thyrotoxic periodic paralysis (HTPP) is a rare entity, a neuromuscular complication of hyperthyroidism. It is more common in male and Asian patients.<a class="elsevierStyleCrossRef" href="#bib0025">1</a>We present the case of a patient affected by HTPP.A 35-year-old Bolivian male patient, with a family history of hyperthyroidism on his mother's side, no toxic habits and no previous pathological history of interest. The patient goes to the emergency department due to generalized weakness with stiffness, muscle cramps and tingling from awakening. The patient reports having lost 20kg of weight this past year, with palpitations along with occasional loose stools with no blood, pus or mucus. Physical examination showed rhythmic heart rate, tachycardia and normal vesicular breath sounds. Neurologically the patient shows normal language, visual field test and cranial nerves. Tetraparesis of proximal predominance. Muscle stimulation (right side): deltoids 2/5, biceps 3/5, triceps and rest of distal muscles 4/5. Muscle stimulation (left side): deltoids 2/5, biceps 2/5, triceps and rest of distal muscles 3/5. Both lower limbs at proximal level 2/5, distal level 3−/5. RMT 1/5 globally. Flexor plantar reflex. The patient has no sensory deficits or sensory level. ECG shows sinus tachycardia with no alterations in QT interval. Blood test with hypokalemia of 1.6mEq/l and rest of parameters within normal levels. Therefore, we started replacement with potassium chloride ev. The blood study is completed with thyrotropin (TSH) <0.014μU/ml, free T4 2.46ng/dl, free T3 4.75pg/ml. It is treated as a hypokalemic thyrotoxic periodic paralysis, therefore the therapy used is propranolol 10mg/8h orally along with thiamazole 5mg/12h. During admission, potassium levels go back to normal along with the patient's symptoms, and the muscle balance improves by 4/5 of all 4 limbs. Thyroid ultrasound is requested that shows moderate growth of the thyroid gland with diffusely heterogeneous echo structure with a few nodules, the largest of 9mm in the right lobe suggestive of thyroiditis without any significant lymphadenopathies. In the blood test, anti-thyroid peroxidase antibodies (TPO) >600IU/ml and anti-thyroglobulin (TG) antibodies 17.5IU/ml stand out. During admission, thyroid scintigraphy showed an enlarged thyroid gland including both lobes (RTL>LTL), with normal location and morphology. Tracer uptake by the thyroid parenchyma is increased, which confirms the state of thyroid gland hyperfunction. The diagnosis of Graves–Basedow disease is confirmed facing these results.In conclusion, HTPP is a very rare disease in our western environment, being more typical in Asian patients. The pathophysiology of this disease is not entirely well defined, but hypokalemia is due to a hyperactive sodium/potassium ATPase pump. This stimulation can be attributed to other etiologies such as hyperinsulinism, resting and the use of beta-adrenergic agents. This is why the first line therapy should be the correction of dyselectrolytemias, hyperthyroidsm and the use of beta blockers to inhibit the activity of the ATPase pump. Some studies have reported the use of prophylactic beta-blockers to prevent the decrease of extracellular potassium, as well as the conversion of T4 to T3, but further research is required.<a class="elsevierStyleCrossRefs" href="#bib0030">2–4</a> We believe that this case is relevant since hyperthyroidism is a very widespread disease, and is a diagnosis to take into account when muscle weakness occurs." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: León J, Muñoz N, Rivero A. Parálisis periódica hipopotasémica tirotóxica, a propósito de un caso. Med Clin (Barc). 2019;153:372." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.W. Kung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2006-0356" "Revista" => array:7 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2006" "volumen" => "91" "paginaInicial" => "2490" "paginaFinal" => "2495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16608889" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806315008336" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism of thyrotoxic periodic paralysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.H. Lin" 1 => "C.L. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2012010046" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "985" "paginaFinal" => "988" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22460532" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thyrotoxic periodic paralysis: an unusual presentation of hyperthyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Salih" 1 => "R.P. Kinschot" 2 => "R.P. Peeters" 3 => "W.W. Herder" 4 => "E.J.J. Duschek" 5 => "J. Linden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neth J Med" "fecha" => "2017" "volumen" => "75" "paginaInicial" => "315" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29219824" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic disorders and nutritional status in autoimmune thyroid diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Kawicka" 1 => "B. Regulska-Ilow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Postepy Hig Med Dosw" "fecha" => "2015" "volumen" => "69" "paginaInicial" => "80" "paginaFinal" => "90" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000009/v1_201911071124/S2387020619304280/v1_201911071124/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000009/v1_201911071124/S2387020619304280/v1_201911071124/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619304280?idApp=UINPBA00004N"]

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Vol. 153. Issue 9.

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