Case Report
Year: 2020 | Month: April-June | Volume: 5 | Issue: 2 | Pages: 139-143
An Interesting Case of Quadriplegia- Thyrotoxic Periodic Paralysis
Bharat Vadlamani1, Sukdev Manna2
1Junior Resident Department of Internal Medicine, All India Institute of Medical Sciences Rishikesh
2Senior Resident Department of Clinical Immunology & Rheumatology, All India Institute of Medical Sciences Rishikesh
Corresponding Author: Bharat Vadlamani
ABSTRACT
Periodic paralysis is a rare neuromuscular disorder related to a defect in muscle ion channels, characterized by episodes of painless muscle weakness, which may be precipitated by heavy exercise, fasting, or high-carbohydrate meals. Periodic paralysis is classified as hypokalemic when episodes occur in association with low potassium blood levels or as hyperkalemic when episodes can be induced by elevated potassium. Most cases of periodic paralysis are hereditary, usually with an autosomal dominant inheritance pattern. Acquired cases of hypokaelemic periodic paralysis have been described in association with hyperthyroidism. In our case who is a 24 year male, presented with 1st episode of acute onset rapidly progressive ascending type of pure motor areflexic flaccid quadriplegia without bowel bladder, cranial nerve involvement with significant weight loss with diffuse thyroid swelling without definite signs and symptoms of hypo or hyperthyroidism without any family history with acholuric jaundice. On further investigating the patient, Grave’s disease was diagnosed along with severe hypokalaemia. A final diagnosis of Grave's disease with thyrotoxic periodic paralysis was made and patient had significant improvement with potassium supplementations, oral carbimazole and propranolol. An advice to avoid heavy meals and strenuous exercises was given.
Keywords: Thyrotoxic periodic paralysis, Hypokaelemia, Quadriplegia, Hypokaelemic periodic paralysis, Grave’s disease, Gilbert’s syndrome