title: Hepatitis C infection and thyrotoxic periodic paralysis--a novel use of an old drug.
abstract: Hypokalaemic thyrotoxic periodic paralysis is an enigmatic and uncommon condition which occurs exclusively in males of Asian descent. The underlying causes of thyrotoxicosis may be any of the well-recognized etiologies including a toxic multinodular goiter, Graves' disease or iodine excess. Beside thyrotoxicosis, a number of other hormonal factors have been hypothesized to contribute to hypokalaemic thyrotoxic periodic paralysis, particularly postprandial hyperinsulinaemia and testosterone. We hereby present a case of a 48-year-old hepatitis C positive gender-assigned man in whom all of these factors are proposed to interact, lending further support to these hypotheses. The patient presented with interferon-induced thyroiditis causing acute generalized weakness whilst undergoing combination interferon-alpha-2beta and ribavirin therapy. As part of his hepatitis C infection, marked insulin resistance with hyperinsulinaemia was also present, exacerbating the paresis. Initial treatment with beta-blocker failed to normalize his serum potassium concentration, requiring the novel use of spironolactone, despite euthyroidism. This continued to be required until his testosterone supplement dissipated.
authors.affiliation: Hunter Area Pathology Service, John Hunter Hospital, Hunter Mail Region Centre, Newcastle, New South Wales, Australia. huy.tran@hnehealth.nsw.gov.au
authors.forename: Huy A
authors.initials: HA
authors.lastname: Tran
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Reeves
mesh_terms: D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013148:Spironolactone / Q000627:therapeutic use*; D014189:Transsexualism
chemical_list: D004232:Diuretics; D013148:Spironolactone