methimazole and Paralysis

Thyrotoxic periodic paralysis (TPP) is an acute complication of hyperthyroidism. Thyrotoxic periodic paralysis is treatable, and the management consists of potassium correction, beta-blockers, and antithyroid drug (ATD) therapy. While TPP is well described in the literature, we describe a case of TPP with urticarial dermographia (UD) that resolved with a short course of antihistamines while continuing ATD therapy. To the best of our knowledge, this is the first reported case of UD after methimazole (MMI) therapy in a TPP patient. A 25-year-old Cambodian active duty male with no significant past medical history presented to the emergency department with acute loss of lower extremity muscle tone with hypokalemia in the setting of previously undiagnosed Graves' disease (GD). He was started on MMI but within 2 weeks developed a rash consistent with UD. This was successfully treated with a second-generation antihistamine while continuing his MMI. Thyrotoxic periodic paralysis is primarily treated by controlling the underlying thyroid disease causing paralysis. Methimazole is commonly chosen as a treatment due to its rapid efficacy and long duration of action. However, adverse effects like UD can occur. Current recommendations are that minor cutaneous reactions can be treated with antihistamines for the management of Graves' disease. However, this case and others show that even moderate reactions can be managed in this manner. In a patient with TPP with UD after treatment with MMI, it is reasonable to attempt a trial of antihistamine before changing to another ATD.

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Male; Methimazole; Paralysis; Potassium; Thyrotoxicosis

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 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

An unusual presentation of periodic paralysis in a Mexican man with thyrotoxicosis is presented. The patient suffered paralysis of the lower extremities without apparent precipitating factors such as hypokalemia, exercise, carbohydrate or alcohol ingestion. Hyperthyroidism was managed first with a thyroid suppressant (methimazole) and propranolol. Prednisone was added after another episode of paralysis. Definitive treatment of hyperthyroidism was achieved with radioactive iodine, which subsequently required substitution therapy with thyroxine. A moderate dose of thyroxine (100 microg) caused muscular weakness. Treatment of thyrotoxicosis and flaccid paralysis as well as the effects of glucocorticoids on thyroid function are discussed.

Topics: Adult; Drug Therapy, Combination; Humans; Male; Methimazole; Paralysis; Potassium; Prednisone; Propranolol; Recurrence; Thyroid Function Tests; Thyrotoxicosis; Thyroxine

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

Topics: Adult; Extremities; Humans; Hyperthyroidism; Male; Methimazole; Nephrotic Syndrome; Paralysis; Periodicity; Recurrence; Remission Induction

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

From 1959 to 1970, 272 operations for thyrotoxicosis were performed. Most of the patients received anti-thyroid drugs and thyroid hormones preoperatively. The patients were continuously followed up. The primary results with low morbidity and no mortality as well as the long term results with a low rate of recurrence and a relatively high incidence of thyroid substitution are discussed. A safe and effective programme for surgical treatment of thyrotoxicosis is described. Anti-thyroid drugs and thyroid hormones should be administered as the method of choice in preparing these patients for surgery.

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Carbimazole; Child; Female; Goiter; Humans; Hyperthyroidism; Hypocalcemia; Hypothyroidism; Laryngoscopy; Length of Stay; Male; Methimazole; Middle Aged; Paralysis; Postoperative Complications; Preoperative Care; Propylthiouracil; Recurrent Laryngeal Nerve; Thyroxine; Triiodothyronine

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

Topics: Antithyroid Agents; Disease; Foot; Humans; Leg; Methimazole; Paralysis