methimazole and Hypokalemia

We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.

Topics: Adult; Graves Disease; Humans; Hyperthyroidism; Hypokalemia; Male; Methimazole; Paralyses, Familial Periodic; Potassium Chloride; Propranolol; Treatment Outcome

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Drug Therapy, Combination; Electrocardiography; Graves Disease; Humans; Hypokalemia; Male; Methimazole; Muscle Weakness; Propranolol; Tachycardia; Thyroidectomy

Topics: Anti-Arrhythmia Agents; Antithyroid Agents; Graves Disease; Humans; Hyperthyroidism; Hypokalemia; Male; Methimazole; Periodicity; Potassium; Propranolol; Quadriplegia; Young Adult

Topics: Acute Disease; Adult; Drug Therapy, Combination; Emergency Service, Hospital; Follow-Up Studies; Humans; Hypokalemia; Lower Extremity; Male; Methimazole; Paralysis; Potassium; Propranolol; Recovery of Function; Thyrotoxicosis; Treatment Outcome

Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis. He was treated with potassium repletion, atenolol and methimazole with complete reversal of his paralysis within the next day. Unfortunately, he failed to keep the follow-up appointment after discharge, ran out of his methimazole and landed up in the ED again.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Antithyroid Agents; Atenolol; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium; Thyrotoxicosis; Thyrotropin; Thyroxine

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Humans; Hyperthyroidism; Hypokalemia; Hypophosphatemia; Lower Extremity; Male; Methimazole; Muscle Weakness; Propranolol; Young Adult

Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective β-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Black or African American; Female; Graves Disease; Humans; Hyperthyroidism; Hypokalemia; Methimazole; Muscle Weakness; Paralysis; Potassium; Propranolol; Respiratory Insufficiency

A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up.

Topics: Adult; Diagnosis, Differential; Graves Disease; Hispanic or Latino; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Immunoglobulins, Thyroid-Stimulating; Iodine Radioisotopes; Male; Methimazole; Muscle Strength; Muscle Weakness; Potassium; Propranolol; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine

Thyrotoxic hypokalemic periodic paralysis (THPP) is a very rare complication of thyrotoxicosis in whites, but is more frequently reported in individuals of Asian descent. Hypokalemia, with associated flaccid paralysis, and signs of hyperthyroidism, are the hallmark. We have reported a case of a 28-yr-old white man with Graves' disease presenting with a 2-wk history of episodic flaccid quadriplegia. Physical examination disclosed a resting tachycardia and symmetrical, proximal weakness involving both arms and legs. Electrocardiogram and electrolyte analysis showed a severe hypokalemia, and thyroid function tests revealed hyperthyroidism. The patient was diagnosed as having Graves' hyperthyroidism and THPP. Paralysis resolved with potassium supplements. He was treated with propranolol and, subsequently, methimazole. He had no further episodes of hypokalemic paralysis. To the best of the author's knowledge, and after a Medline search, THPP has not been described previously in a Turkish man.

Topics: Adult; Antithyroid Agents; Electrocardiography; Graves Disease; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Male; Methimazole; Potassium Chloride; Thyrotoxicosis; Water-Electrolyte Balance

A 19-year-old man had mild diarrhoea at the time that suddenly one night he was unable to turn in his bed and the following morning could not move his arms and legs for 4 hours. Neither he nor any family members had previously had any paralysis. Physical examination was unremarkable except for mild tachycardia and first-degree goitre.. A provocation test with glucose (3 g/kg) and insulin (0.1 IU/kg) caused renewed paralysis for several hours, serum potassium falling from 4.3 to 3.4 mmol/l. The paralysis was reversed on oral potassium (40 mmol) Thyroid function tests revealed hyperthyroidism with an increased concentration of free thyroxine (25.5 pg/ml) and free triiodothyronine (9.7 pg/ml), while thyroid-stimulating hormone was decreased (0.07 mU/I), supporting the diagnosis of autoimmune thyroiditis.. Thyrostatic treatment was started with thiamazole (10 mg every other day). There was no further periodic paralysis and another provocation test was negative.. Fleeting paralysis is often misdiagnosed as being psychogenic. Potassium abnormalities are the most common cause but are only rarely associated with hyperthyroidism. This case of thyrotoxic hypokalaemic paralysis was probably based on a genetic defect of muscle fibre membrane manifesting itself only in the presence of hyperthyroidism.

Topics: Adult; Antithyroid Agents; Diagnosis, Differential; Diarrhea; Electromyography; Glucose; Humans; Hyperthyroidism; Hypokalemia; Insulin; Male; Methimazole; Paralysis; Potassium; Radionuclide Imaging; Thyroid Function Tests; Thyroid Gland; Thyroiditis, Autoimmune; Thyrotropin; Thyroxine; Triiodothyronine; Ultrasonography

For the first time in Bulgaria a case of hypokalemic periodic paralysis in thyrotoxicosis is described. Three periods of paralysis were observed and documented in a hospital. The thyrotoxicosis was well manifested with disturbed carbohydrate tolerance and responded favourably to methizole treatment. It is suggested that the mechanism for the development of the hypokalemic periodic paralysis is the intracellular blockade of potassium by the surplus of thyroid hormones.

Topics: Adult; Drug Therapy, Combination; Humans; Hypokalemia; Male; Methimazole; Paralyses, Familial Periodic; Propranolol; Thyrotoxicosis

We present the case of a 21-year-old man who presented to the emergency department with an episode of profound weakness due to thyrotoxic periodic paralysis, a syndrome of muscular weakness occurring in patients with hyperthyroidism. Prior to the diagnosis, the patient was treated with a parenteral tranquilizer. When hypokalemia was discovered, potassium was administered, resulting in the development of hyperkalemia. Episodes of thyrotoxic periodic paralysis are usually self limited, and recovery of motor strength is complete. However, potassium is frequently administered to hasten recovery and prevent cardiac arrhythmias and respiratory arrest. Serum potassium must, therefore, be monitored carefully in these patients during treatment.

Topics: Adult; Humans; Hyperkalemia; Hypokalemia; Male; Methimazole; Paralyses, Familial Periodic; Potassium; Propranolol; Thyrotoxicosis

Topics: Adult; Humans; Hypokalemia; Male; Methimazole; Paralysis; Periodicity; Propranolol; Recurrence; Thyrotoxicosis

Topics: Adolescent; Diabetic Ketoacidosis; Female; Graves Disease; Humans; Hypokalemia; Insulin; Iodine; Methimazole; Potassium Chloride; Thyroid Crisis; Triiodothyronine; Tromethamine

Topics: Acetazolamide; Adult; Humans; Hypokalemia; Iodine Isotopes; Male; Methimazole; Mineralocorticoid Receptor Antagonists; Paralysis; Periodicity; Potassium Chloride

Topics: Adult; Antithyroid Agents; Electromyography; Humans; Hyperthyroidism; Hypokalemia; Male; Methimazole; Paralysis; Periodicity; Propylthiouracil; Reserpine; Thyroid Function Tests