propylthiouracil and Hypokalemia

We report the rare case of a 43-year-old African-American man with thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia. Both serum potassium and serum phosphate levels returned to normal after supplementation with only potassium. We consider the unusual condition of hyperthyroid-related hypokalemia and hypophosphatemia to have contributed to the acute paralysis in this patient.

Topics: Acute Disease; Adult; Antithyroid Agents; Graves Disease; Humans; Hypokalemia; Hypophosphatemia; Infusions, Intravenous; Male; Paralysis; Periodicity; Potassium Chloride; Propylthiouracil; Thyrotoxicosis

Presentations of acute systemic weakness are rare and appear dramatic and frightening to both patients and physicians. Aetiologies are multifactorial and diverse. Morbidity and mortality are associated with the unrecognized disease. One of the underlying disorders is hypokalaemic thyrotoxic periodic paralysis (HTPP), an uncommon disorder. HTPP is characterized by periodic occurrences of muscle weakness during attacks of hyperthyroidism and appears predominantly in Orientals. This article describes a patient of Chinese origin with hyperthyroidism and attacks of paralysis and considers several problems: a lack of familiarity with the syndrome, increasing numbers of patients with this disease in European hospitals as a result of migration of populations, and the importance of patient compliance in therapeutic management. Finally, a review of the literature concerning presentation, differential diagnosis, pathophysiology, and therapeutic management is provided.

Topics: Adrenergic beta-Antagonists; Adult; Anti-Inflammatory Agents; Antithyroid Agents; Humans; Hypokalemia; Male; Paralysis; Potassium Chloride; Prednisolone; Propranolol; Propylthiouracil; Syndrome; Thyrotoxicosis

Topics: Desoxycorticosterone; Dogs; Epinephrine; Heart Diseases; Hyperthyroidism; Hypokalemia; Isoproterenol; Myocardial Infarction; Necrosis; Norepinephrine; Potassium Deficiency; Propylthiouracil; Rats; Research; Thyroidectomy; Toxicology

BACKGROUND Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. CASE REPORT Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. She presented with muscle weakness, nausea, vomiting, and diarrhea since one week. The initial diagnosis was TPP. However, biochemistry tests showed hypokalemia with metabolic alkalosis and renal potassium wasting. Moreover, a suppressed plasma renin level and a high plasma aldosterone level were noted, which was suggestive of primary aldosteronism. Abdominal computed tomography confirmed this diagnosis. CONCLUSIONS Therefore, it is imperative to consider other causes of hypokalemia (apart from TPP) in a patient with hyperthyroidism but with renal potassium wasting and metabolic alkalosis. This can help avoid delay in diagnosis of the underlying disease.

Topics: Adrenergic beta-Antagonists; Adult; Aldosterone; Antithyroid Agents; Biomarkers; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Hyperaldosteronism; Hyperthyroidism; Hypokalemia; Paralysis; Potassium; Propranolol; Propylthiouracil; Renin; Treatment Outcome

Thyrotoxic periodic paralysis is rare in Caucasian populations, but affects approximately 2% of East Asians with thyrotoxicosis (13% of males, 0.17% of females). The presentation is characterized by abrupt-onset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise.. To raise awareness of this condition through the description of a typical case of thyrotoxic periodic paralysis; to remind readers that, despite intravascular hypokalemia, total body potassium is normal and that correction must be done with caution; to highlight the differences in treatment compared to familial hypokalemic periodic paralysis.. We describe the presentation of a 36-year-old Filipino man with a background history of Graves disease. Over-administration of intravenous potassium was narrowly averted in this case.. It may be important to check thyroid function in patients presenting with acute paralysis, especially those of Asian origin. In patients with thyrotoxic periodic paralysis, administration of potassium, with cardiac monitoring and a total dose of <50 mmol, limits the dysrhythmia risk. Patients are likely to benefit from the prescription of non-selective beta-blockers until they become euthyroid. In contrast to familial periodic paralysis, regular oral potassium supplementation is ineffective in thyrotoxic periodic paralysis, and acetazolamide precipitates, rather than prevents, attacks.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Graves Disease; Humans; Hypokalemia; Male; Muscle Weakness; Potassium; Propranolol; Propylthiouracil; Thyrotoxicosis

Hypokalemic periodic paralysis is a rare life-threatening syndrome, potentially reversible when detected at an early stage. Hypokalemia may also occur in other conditions characterized by muscle weakness. Acute myopathy associated with thyrotoxicosis has been described in Asian populations, although it seldom affects Caucasians or African-Americans. It can be difficult to recognize in western populations. Acute recurrent episodes of flaccid paralysis, symmetrically affecting the proximal muscles of the lower limbs, either following strenuous physical activity or carbohydrate overindulgence, is the usual presentation. Hypokalemia seems to result from transcellular shifts of potassium rather than losses. A case of thyrotoxic hypokalemic periodic paralysis occurring in a young Caucasian male diagnosed with Graves' disease is reported.

Topics: Antithyroid Agents; Humans; Hypokalemia; Male; Muscle Weakness; Paralysis; Propylthiouracil; Thyrotoxicosis; Young Adult

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Hypokalemia; Male; Periodicity; Propylthiouracil; Quadriplegia; Thyrotoxicosis

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Hypokalemia; Male; Periodicity; Propylthiouracil; Quadriplegia

Hypopotassaemic periodic paralysis as the sole manifestation of hyperthyroidism. Hypopotassaemic periodic paralysis is a rare disorder that is found in certain families, sporadically or in association with certain diseases. The association with hyperthyroidism is almost wholly restricted to south-east Asian males. It is characterized by attacks of subacute paralysis, starting most often early in the morning and lasting some hours to a few days. We present a 42-year-old patient of Indonesian origin, who experienced four attacks of paralysis before underlying hyperthyroidism was diagnosed. The mechanism is based on potassium shift into the muscle cell due to higher activity of the Na-K-ATP-ase pump, under the influence of beta-adrenergic stimulation and thyroid hormone. Treatment with antithyroidal medication and beta-blockers led to the complete abolition of attacks.

Topics: Adult; Humans; Hyperthyroidism; Hypokalemia; Male; Paralyses, Familial Periodic; Propylthiouracil

Thyrotoxic periodic paralysis (TPP) is an uncommon syndrome that can be fatal. We report the case of a patient with acute, severe muscle weakness and hypokalemia who was diagnosed in the emergency department to have thyrotoxicosis with acute TPP. The hypokalemia was treated aggressively with potassium without effect. After administration of i.v. propranolol, the patient had complete resolution of symptoms, with mild rebound hyperkalemia. The literature on the use of propranolol in TPP is reviewed, and the known pathophysiology of TPP is discussed.

Topics: Adult; Drug Therapy, Combination; Electrocardiography; Humans; Hypokalemia; Male; Paralysis; Potassium Chloride; Propranolol; Propylthiouracil; Thyrotoxicosis

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