Associates' Presentations
| Intro | Prev | Next | Last |
Thyrotoxic periodic paralysis.
Sharon Cline, M.D., (Associate), James Cerletty, M.D., Medical College of Wisconsin.
Case - A 27 year old white male presented with sudden onset of bilateral lower extremity paralysis. The evening prior to the event, he consumed several alcoholic beverages and complained of generalized weakness but no loss of strength. The next morning he was able to move his legs but was unable to bear weight. Upon arrival to the Emergency Department he was only able to contract the muscles in his legs. The paralysis rapidly progressed to involve the abdominal muscles and proximal upper extremities and he was no longer able to initiate urination. He denied any loss of sensation, difficulty breathing or recent viral illness. However, he complained of recent palpitations, tremors and a 19 pound weight loss over the previous two weeks.
His examination was significant for symmetric motor weakness affecting the lower extremities, and the proximal muscles more than the distal muscles. The rest of the neurological exam was intact. Laboratory studies revealed a potassium of 1.8 TSH less than 0.03 and FTI of 4.9 (normal 1.4-4.0). The patient's potassium was supplemented and he was then started on methimazole with complete resolution of his symptoms. The patient's presenting complaints, physical examination, laboratory findings and response to treatment is diagnostic of thyrotoxic periodic paralysis.
Discussion - Thyrotoxic Periodic Paralysis (TPP) is a rare complication of hyperthyroidism. It is seen predominantly in Asian males and can be exacerbated by a high carbohydrate diet, alcohol consumption and a prolonged period of rest after vigorous exercise. These activities increase the sodium-potassium ATPase pump, causing an intracellular shift of potassium and thus a paralytic attack. However, the only definitive treatment is to achieve a euthyroid state by treating the hyperthyroidism.
| Intro | Prev | Next | Last |
What's New
Contact Information
Sharon Haase, MD, FACP
Chapter Governor
Kelly Lang
Chapter Support Staff
Ph: 414-755-6280
E-mail: lang@svinicki.com