propylthiouracil and Paralysis

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

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot.

Topics: Adolescent; Antithyroid Agents; Biopsy; Female; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Muscle, Skeletal; Muscular Diseases; Necrosis; Paralysis; Propylthiouracil; Thyrotoxicosis

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

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

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; Graves Disease; Humans; Infusions, Intravenous; Male; Paralysis; Potassium; Propranolol; Propylthiouracil; Thyrotoxicosis

We describe a case of a 29-year-old man with hyperthyroidism associated with autoimmune hemolytic anemia and periodic paralysis. Euthyroidism, which was achieved by propylthiouracil, brought inhibition of hemolysis and amelioration of anemia in spite of continuously positive direct and indirect Coombs' tests. Neither adrenocortical steroid nor blood transfusion was administered. Since indirect monospecific Coombs' test was negative against anti-human complements serum, the membrane of red blood cells may be less fragile. This is one reason why hemolysis was inhibited by anti-hyperthyroid therapy only. This may indicate that the hyperdynamic circulatory state secondary to hyperthyroidism plays an important role in the destruction of red blood cells which were coated by anti-red blood cell antibody.

Topics: Adult; Anemia, Hemolytic, Autoimmune; Coombs Test; Hemolysis; Humans; Hyperthyroidism; Male; Paralysis; Periodicity; Propylthiouracil

A case of thyrotoxic periodic paralysis based on clinical grounds, laboratory data and therapeutic response as well is reported. The authors comment on the differential diagnosis with the most frequent types of periodic paralysis. The importance of a correct diagnosis and treatment as early as possible is stressed as to prevent further development of permanent paralysis due to irreversible degenerative myofibril changes as stated in literature.

Topics: Adult; Carbohydrate Metabolism; Diagnosis, Differential; Humans; Hyperthyroidism; Male; Membrane Potentials; Microscopy, Electron; Myofibrils; Paralyses, Familial Periodic; Paralysis; Propylthiouracil

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: Adolescent; Adult; California; Humans; Hyperthyroidism; Male; Mexico; Paralysis; Philippines; Propylthiouracil

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

Topics: Adult; Familial Mediterranean Fever; Humans; Hyperthyroidism; Male; Paralysis; Propylthiouracil