Keywords
Periodic Paralysis
Thyrotoxicosis
Hyperthyroidism
Graves' disease
Antithyroidism
Learning
How to Cite
Abstract
Introduction: Graves' disease is associated with Periodic Hypokalemic Paralysis (PPHC). Given the interesting particularities of this association in medical practice and learning, we have shared the present case.
Purpose: To report the clinical and laboratory findings of a patient who presented with generalized weakness secondary to PPHC as the debut of Graves' disease, without other manifestations of thyrotoxicosis.
Case presentation: A 44-year-old male patient consulted the emergency department for flaccid quadriparesis, previously self-medicated with dexamethasone for lower back pain. Serum potassium of 1.9 mmol/L, TSH level < 0.005 ?UI/mL, positive antiTRAb, and diffuse hypercapillary goiter. PPHC secondary to Graves’ disease was diagnosed. The patient improved with hydroelectrolyte replacement and use of Beta blockers and antithyroid drugs.
Discussion: Hyperthyroidism is associated with multiple systemic manifestations, such as PPHC, which, despite being an infrequent finding in Graves' disease, was the only clinical manifestation in the patient. Patients with PPHC rarely present with paralysis and no signs of hyperthyroidism. However, the exact mechanism of action of PPHC in thyrotoxicosis remains unclear. In this case, it is hypothesized that self-medication with steroids may have worsened the hypokalemia.
Conclusion: Although infrequent, PPHC causes generalized weakness. A high index of clinical suspicion is key to the timely ordering of electrolytes, along with the systematic search for diseases that are associated with hypokalemia and weakness, such as Graves' disease.
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