Thyrotoxic Periodic Paralysis with Sensory Deficits in Young African American Male: A Case Report and Literature Review

Irsa Munir MD¹, Talha Mehmood MD¹, Kaiser Islam¹, Lina Soni¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

Cite this paper

Irsa Munir MD, Talha Mehmood MD, Kaiser Islam, Lina Soni and Samy I. McFarlane. Thyrotoxic Periodic Paralysis with Sensory Deficits in Young African American Male: A Case Report and Literature Review. American Journal of Medical Case Reports. 2019; 7(7):138-142. doi: 10.12691/AJMCR-7-7-5

Abstract

Thyrotoxic periodic paralysis is a sporadic entity characterized by hypokalemia and paralysis in the setting of hyperthyroidism. TPP is most commonly described in young Asian males. Studies have shown an association with mutations affecting inward rectifying potassium channels. The pathophysiology involves Na⁺-K⁺- ATPase channel causing an increased intracellular shift of potassium ions in the hyperthyroid state and in the presence of another precipitating condition. Most cases of thyrotoxic periodic paralysis are defined in young Asian males of 20-40 years of age, here we present an interesting case of thyrotoxic periodic paralysis in 32-year-old African American male, who presented with sudden onset weakness in the bilateral lower extremity and left upper extremity. Interestingly, the patient also has sensory deficits, a feature not known to be associated with thyrotoxic periodic paralysis.

Keywords

thyrotoxic periodic paralysis, hypokalemia, african american

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Tella, Sri Harsha, and Anuhya Kommalapati. “Thyrotoxic periodic paralysis: an underdiagnosed and under-recognized condition.” Cureus 7.10 (2015).
[2]	Vijayakumar, Abhishek, Giridhar Ashwath, and Durganna Thimmappa. “Thyrotoxic periodic paralysis: clinical challenges.” Journal of thyroid research 2014 (2014).
[3]	Ryan, Devon P., et al. “Mutations in potassium channel Kir2. 6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis.” Cell 140.1 (2010): 88-98.
[4]	Song, I-Wen, et al. “Novel susceptibility gene for nonfamilial hypokalemic periodic paralysis.” Neurology 86.13 (2016): 1190-1198.
[5]	Kung, Annie WC. “Thyrotoxic periodic paralysis: a diagnostic challenge.” The Journal of Clinical Endocrinology & Metabolism 91.7 (2006): 2490-2495.
[6]	McFadzean, A. J., and Rose Yeung. “Periodic paralysis complicating thyrotoxicosis in Chinese.” British Medical Journal 1.5538 (1967): 451.
[7]	Finsterer, J. “Primary periodic paralyses.” Acta Neurologica Scandinavica 117.3 (2008): 145-158.
[8]	Hagel, Stefan, et al. “Chest pain and paralysis after pulse prednisolone therapy an unusual case presentation of thyrotoxic periodic paralysis: a case report.” Cases journal 2.1 (2009): 7501.
[9]	Lin, Shih-Hua, and Chou-Long Huang. “Mechanism of thyrotoxic periodic paralysis.” Journal of the American Society of Nephrology (2012): ASN-2012010046.
[10]	Manoukian, Mariam Avakian, Julie A. Foote, and Lawrence M. Crapo. “Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes.” Archives of Internal Medicine 159.6 (1999): 601-606.
[11]	Lee, Kok Onn, et al. “Hyperinsulinaemia in thyrotoxic hypokalaemic periodic paralysis.” The Lancet 337.8749 (1991): 1063-1064.
[12]	Chan, A., et al. “Hyperinsulinaemia and Na+, K+-ATPase activity in thyrotoxic periodic paralysis.” Clinical endocrinology. 41.2 (1994): 213-216.
[13]	Ruff, Robert L. “Insulin acts in hypokalemic periodic paralysis by reducing inward rectifier K current.” Neurology 53.7 (1999): 1556-1556.
[14]	Puwanant, Araya, and Robert L. Ruff. “INa and IKir are reduced in Type 1 hypokalemic and thyrotoxic periodic paralysis.” Muscle & nerve 42.3 (2010): 315-327.
[15]	Ireland, M. A., et al. “Acute effects of moderate alcohol consumption on blood pressure and plasma catecholamines.” Clinical science (London, England: 1979) 66.6 (1984): 643-648.
[16]	Kim, Soo-Jeong, and Dai-Jin Kim. “Alcoholism and diabetes mellitus.” Diabetes & metabolism journal 36.2 (2012): 108-115.
[17]	Lulsegged, Abbi, Christina Wlodek, and Michela Rossi. “Thyrotoxic periodic paralysis: case reports and an up-to-date review of the literature.” Case reports in endocrinology 2011 (2011).
[18]	Belayneh, Dereje K., and Thomas Kellerth. “Thyrotoxic hypokalemic periodic paralysis in an African male: a case report.” Clinical case reports 3.2 (2015): 102-105.
[19]	Naqi, Muniba, et al. “A 20-year-old Chinese man with recurrent hypokalemic periodic paralysis and delayed diagnosis.” BMJ case reports 2012 (2012): bcr0120125541.
[20]	Zumo, Lawrence A., Christian Terzian, and Timothy Brannan. “Thyrotoxic hypokalemic periodic paralysis in a Hispanic male.” Journal of the National Medical Association 94.5 (2002): 383.
[21]	Oh, Sang Bo, et al. “Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to painless thyroiditis.” Journal of Korean medical science 27.7 (2012): 822-826.
[22]	Thethi, Tina K., et al. “Case of thyrotoxic periodic paralysis in a caucasian male and review of literature.” Case reports in medicine 2014 (2014).
[23]	Barahona, M. J., et al. “Thyrotoxic periodic paralysis: a case report and literature review.” Clinical medicine & research. (2009): cmr-2009.
[24]	Lam, Lien, Rajasree J. Nair, and Leslie Tingle. “Thyrotoxic periodic paralysis.” Baylor University Medical Center Proceedings. Vol. 19. No. 2. Taylor & Francis, 2006.
[25]	Meseeha, Marcelle, et al. “Thyrotoxic periodic paralysis: a case study and review of the literature.” Journal of community hospital internal medicine perspectives 7.2 (2017): 103-106.
[26]	Hegde, Swati, Mohammed Aslam Shaikh, and Thejaswi Gummadi. “Hypokalaemic periodic paralysis in a patient with subclinical hyperthyroidism: a rare case.” Journal of clinical and diagnostic research: JCDR 10.1 (2016): OD14.
[27]	Hakami, Osamah, Maswood M. Ahmad, and Naji Al Johani. “A Case of Nonfatal Ventricular Arrhythmia Due to Thyrotoxic Periodic Paralysis in a Saudi Patient as an Initial Presentation of Graves’ Disease.” Clinical Medicine Insights: Case Reports9 (2016): CCRep-S34560.
[28]	Sehmer, Benjamin, and Terra Arnason. “Pop-provoked paralysis: silent Graves’ disease presenting as thyrotoxic periodic paralysis.” BMJ case reports 2012 (2012): bcr2012006292.
[29]	Jung, Se Yong, et al. “A case of thyrotoxic periodic paralysis as initial manifestation of Graves' disease in a 16-year-old Korean adolescent.” Annals of pediatric endocrinology & metabolism 19.3 (2014): 169.