Thyrotoxic hypokalemic periodic paralysis

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Neeraj Singh
2. Satyendra Sonkar
ISSN
0972-5229
DOI
10.4103/ijccm.IJCCM_369_17
Volume
22
Issue
5
Publishing Year
2018
Pages
3
Author Affiliations
    1. Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
    1. Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
  • Article keywords
    Hyperthyroidism, hypokalemia, quadriparesis

    Abstract

    Hypokalemia is a serious and life-threatening clinical condition. We present a case of a 45-year-old male, with known hyperthyroidism presenting with profound tremor, irritability, quadriparesis, and labored breathing since morning, on the day of admission. Arterial blood gas analysis showed severe hypokalemia. Patient's vital was stabilized and patient's oxygen saturation was maintained on oxygen inhalation. Intravenous potassium chloride infusion was administered with regular monitoring of vitals and electrolytes. Patient's symptoms improved. Thyroid function testing showed high free T3 (tri-iodothyronine) and free T4 (thyroxine) with low thyroid-stimulating hormone concentration in the serum, indicating thyrotoxic hypokalemic periodic paralysis. Treatment with antithyroid drug carbimazole resulted in an improvement during the follow-up visit. Hypokalemia is believed to be a consequence of a massive shift due to increased sodium–potassium–adenosine triphosphatase (Na+K+ATPase) pump activity in the presence of elevated thyroid hormones.

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