title: Hypokalemic Paralysis Complicated by Concurrent Hyperthyroidism and Hyperaldosternoism: A Case Report.
abstract: BACKGROUND Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. CASE REPORT Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. She presented with muscle weakness, nausea, vomiting, and diarrhea since one week. The initial diagnosis was TPP. However, biochemistry tests showed hypokalemia with metabolic alkalosis and renal potassium wasting. Moreover, a suppressed plasma renin level and a high plasma aldosterone level were noted, which was suggestive of primary aldosteronism. Abdominal computed tomography confirmed this diagnosis. CONCLUSIONS Therefore, it is imperative to consider other causes of hypokalemia (apart from TPP) in a patient with hyperthyroidism but with renal potassium wasting and metabolic alkalosis. This can help avoid delay in diagnosis of the underlying disease.
authors.affiliation: Department of Medicine, Fu-Jen Catholic University School of Medicine, Taipei, Taiwan.
authors.forename: Yu-Hsin
authors.initials: YH
authors.lastname: Hsiao
authors.affiliation: Department of Medicine, Fu-Jen Catholic University School of Medicine, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Fang
authors.affiliation: Department of Medicine, Fu-Jen Catholic University School of Medicine, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Jyh-Gang
authors.initials: JG
authors.lastname: Leu
authors.affiliation: Department of Medicine, Fu-Jen Catholic University School of Medicine, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Hsein
authors.initials: MH
authors.lastname: Tsai
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D013956:Antithyroid Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006980:Hyperthyroidism / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007008:Hypokalemia / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010243:Paralysis / Q000175:diagnosis / Q000209:etiology*; D011188:Potassium / Q000097:blood*; D011433:Propranolol / Q000627:therapeutic use; D011441:Propylthiouracil / Q000627:therapeutic use; D012083:Renin / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D015415:Biomarkers; D000450:Aldosterone; D011441:Propylthiouracil; D011433:Propranolol; D012083:Renin; D011188:Potassium