Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department

Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present...

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Main Authors: Nick Si Rui Lan, P. Gerry Fegan
Format: Article
Language:English
Published: Wiley 2018-01-01
Series:Case Reports in Endocrinology
Online Access:http://dx.doi.org/10.1155/2018/9763452
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author Nick Si Rui Lan
P. Gerry Fegan
author_facet Nick Si Rui Lan
P. Gerry Fegan
author_sort Nick Si Rui Lan
collection DOAJ
description Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient’s symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves’ disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves’ disease and should be considered in the differential diagnosis in patients presenting with weakness.
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spelling doaj-art-1e228bba12d348c8a55a2ea2ed1fd17c2025-08-20T03:54:34ZengWileyCase Reports in Endocrinology2090-65012090-651X2018-01-01201810.1155/2018/97634529763452Graves’ Disease Presenting with Periodic Paralysis to the Emergency DepartmentNick Si Rui Lan0P. Gerry Fegan1Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150, Western Australia, AustraliaFiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150, Western Australia, AustraliaThyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient’s symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves’ disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves’ disease and should be considered in the differential diagnosis in patients presenting with weakness.http://dx.doi.org/10.1155/2018/9763452
spellingShingle Nick Si Rui Lan
P. Gerry Fegan
Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
Case Reports in Endocrinology
title Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
title_full Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
title_fullStr Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
title_full_unstemmed Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
title_short Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department
title_sort graves disease presenting with periodic paralysis to the emergency department
url http://dx.doi.org/10.1155/2018/9763452
work_keys_str_mv AT nicksiruilan gravesdiseasepresentingwithperiodicparalysistotheemergencydepartment
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