Abstract
Hypothyroidism, a commonly encountered thyroid disorder, usually manifests with readily
recognizable typical features. However, an unusual presentation of a classic thyroid
disorder may hinder accurate diagnosis in certain instances. One such rare initial
presentation of hypothyroidism is recurrent hypokalemic paralysis, and existing reports
in the literature are sparse. It has been more commonly reported in thyrotoxicosis.
We report the case details and clinical outcomes of two middle-aged individuals (a
34-year-old male and a 37-year-old female) with recurrent episodes of hypokalemic
paralysis. Their clinical examination revealed pure motor hyporeflexia quadriparesis
with hypotonia and diminished deep tendon reflexes without any autonomic dysfunction.
They had no significant previous medical history. Biochemical findings revealed hypokalemia
in both cases (1.4 and 1.9 mEq/L, respectively) with elevated levels of thyroid‑stimulating
hormone and thyroid‑related antibodies in both individuals, thus, confirming the diagnosis
of autoimmune hypothyroidism. Immediate treatment with intravenous and oral potassium
correction helped in the recovery. Thyroxine supplementation was considered a follow-up
treatment, and for a one-year follow-up period there were no complaints of limb weakness
reported in both individual.
Key Indexing Terms
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References
- Hypokalaemic paralysis.Postgrad Med J. 1999; 75: 193-197
- Periodic paralysis as an unusual presentation of autoimmune hypothyroidism with goiter.Clin Pediatr (Phila). 2009; 48: 677-678
- Hypokalemic periodic paralysis associated with hypothyroidism.Indian J Phy Med Rehab. 2012; 23: 79-81
- Clinical and biochemical spectrum of hypokalemic paralysis in North: East India.Ann Indian Acad Neurol. 2013; 16: 211-217
- Recurrent hypokalemic paralysis: An atypical presentation of hypothyroidism.Indian J Endocrinol Metab. 2013; 17: 174-176
- Hypothyroidism with recurrent hypokalemic paralysis.Int J Sci Re. 2017; 6: 2131-2132
- Clinical and aetiological spectrum of hypokalemic flaccid paralysis in Western Odisha.J Assoc Physicians India. 2016; 64: 52-58
- Etiological and biochemical profile of hypokalemic paralysis in North‑West India.Int J Sci Res. 2017; 6: 203‑206
- Hypokalaemic periodic paralysis: rare presentation of hypothyroidism.JIACM. 2017; 18: 306-307
- Hypokalemic periodic paralysis and spectrum of thyroid disorders: analysis of 7 cases from Northern India.Indian J Endocrinol Metab. 2019; 23: 168-170
- Profile of patients with hypokalemic periodic paralysis.Int J Med Rev Case Rep. 2021; 5: 26-32
- Practical approach to the patient with acute neuromuscular weakness.World J Clin Cases. 2017; 5: 270-279
- Acute neuromuscular weakness in the intensive care unit.Crit Care Med. 2006; 34: 2835-2841
- Dengue infection in North India: An experience of a tertiary care center from 2012 to 2017.Tzu Chi Med J. 2019; 32: 36-40
- A rare presentation of dengue fever: acute motor quadriparesis due to hypokalemia.Int J Res Med Sci. 2014; 2: 1732-1734
- Demographic, clinical, investigational characteristics of COVID-19 related Guillain-Barré syndrome with differences from typical and another virus-related Guillain-Barré syndrome.Infect Disord Drug Targets. 2022; https://doi.org/10.2174/1871526522666220429134113
- Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty's Stationery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8]64 and 94 Figures.Brain. 2010; 133: 2838-2844
- Prevalence of hypothyroidism in the population of West Bokaro coal mine area, Jharkhand: a Hospital-Based Observational Study.Cureus. 2022 Sep 3; 14: e28733
- Unusual manifestations associated with primary hypothyroidism: experience from A Tertiary Care Health Center.J ASEAN Fed Endocr Soc. 2017; 32: 60-67
- Recurrent nausea and vomiting with weight loss associated with hypothyroidism: Fact or Myth.Endocr Metab Immune Disord Drug Targets. 2022; https://doi.org/10.2174/1871530323666221205110210
- A case of hypokalemic myopathy associated with transient hypothyroidism.Endocrinol Jpn. 1984; 31: 809-814
- A case of hypothyroidism associated with hypokalemic periodic paralysis.Rinsho Shinkeigaku. 1990; 30: 100-102
- Hypokalemic paralysis during management of hypothyroidism.Indian Pediatr. 2000; 37: 1261-1263
- Hypokalemic paralysis revealing Sjögren's syndrome associated with autoimmune thyroiditis.Nephrol Ther. 2010; 6: 52-56
- Spectrum of hypokalaemic periodic paralysis in a tertiary care centre in India.Postgrad Med J. 2010; 86: 692-695
- Distal renal tubular acidosis, hypokalemic paralysis, nephrocalcinosis, primary hypothyroidism, growth retardation, osteomalacia and osteoporosis leading to pathological fracture: a case report.Oman Med J. 2011; 26: 271-274
- Distal renal tubular acidosis, and hypokalemic paralysis in a patient with hypothyroidism.Saudi J Kidney Dis Transpl. 2011; 22: 1014-1016
- A possible association of hypokalaemic periodic paralysis, autoimmune thyroiditis and neuromyotonia.Ceylon Med J. 2013; 58: 175-176
- Adult-onset distal renal tubular acidosis with hypokalemic quadriparesis in a patient with autoimmune hypothyroidism.J Integr Nephrol Androl. 2014; 1: 82-84
- Pediatric Sjogren syndrome with distal renal tubular acidosis and autoimmune hypothyroidism: an uncommon association.CEN Case Rep. 2015; 4: 200-205
- Approach of the patient with hypokalemia caused Hashimoto's thyroiditis with primary Sjogren's syndrome by and renal tubular acidosis.Chin J Endocrinol Metab. 2016; 32: 349-352
- Sporadic hypothyroidism-related hypokalemic paralysis: diagnosis in a resource-poor setting.J Family Med Prim Care. 2017; 6: 862-864
- Hypokalemic paralysis: a hidden card of several autoimmune diseases.Clin Med Insights Arthritis Musculoskelet Disord. 2017; 10: 1-4
- Distal renal tubular acidosis in two children with acquired hypothyroidism.Nefrologia (Engl Ed). 2018; 38: 655-659
- Report: Recurrent hypokalemic periodic paralysis associated with distal renal tubular acidosis (type 1) and hypothyroidism secondary to Hashimoto's thyroiditis.F1000Res. 2018; 7: 1154
- Hypothyroid myopathy with periodic paralysis as the main symptom: a case report and literature review.Ann Palliat Med. 2020; 9: 3698-3704
Goretti L, Edijanto SP. Hypokalemic periodic paralysis and renal tubular acidosis in patient with hypothyroidism. Indian J Foren Med Toxicol. 202;15(3):3431-35.
- Aryati. Hypokalemic periodic paralysis and renal tubular acidosis in a patient with hypothyroid and autoimmune disease.Ann Med Surg (Lond). 2022 Feb 22; 75103389
- Hypokalemic periodic paralysis: an atypical presentation of non-autoimmune hypothyroidism with distal renal tubular acidosis.Cureus. 2022; 14 (Apr 11): e24046
- Hypokalaemia, and paralysis.QJM. 2001; 94: 133-139
- Aetiological, clinical, and metabolic profile of hypokalaemic periodic paralysis in adults: a single-centre experience.Natl Med J India. 2006; 19: 246-249
- Neurologic causes of weakness and paralysis.in: Jameson J Fauci AS Kasper DL Hauser SL Longo DL Loscalzo J Harrison's Principles of Internal Medicine, 20e. McGraw Hill, 2018: 135-138 (20Accessed Apr 25 2022)
Article info
Publication history
Published online: February 06, 2023
Accepted:
January 30,
2023
Received:
September 21,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
