title: An Unusual Case of Acute Muscle Weakness.
abstract: A previously healthy 35-year old man presented to hospital with acute leg weakness following an alcohol binge. On assessment, tachycardia, urinary retention and bilateral upper and lower limb proximal weakness with preserved peripheral power were noted. Biochemistry revealed marked hypokalaemia, which responded to intravenous replacement, and biochemical thyrotoxicosis, leading to the diagnosis of Thyrotoxic Periodic Paralysis (TPP). Anti-thyroid therapy and beta-blockers were commenced and his neurological symptomatology resolved as he became progressively euthyroid. TPP is a rare acquired subtype of hypokalaemic periodic paralysis, typically causing proximal muscle weakness associated with thyrotoxicosis. It is most common in young Asian males. Acute treatment requires cautious oral potassium supplementation, beta-blockade, and anti-thyroid therapy. TPP is prevented by maintaining euthyroidism; otherwise recurrence is likely.
authors.affiliation: BMBCh BA (Oxon), Academic Foundation Year 2 Doctor, Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London.
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Harrogate
authors.affiliation: MRCP, ST5 Endocrinology/GIM, Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London.
authors.forename: Edouard
authors.initials: E
authors.lastname: Mills
authors.affiliation: FRCP, Consultant Endocrinologist, London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow.
authors.forename: Asjid
authors.initials: A
authors.lastname: Qureshi
authors.affiliation: MRCP(Acute), Consultant Acute Physician, London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow.
authors.forename: Jacob F
authors.initials: JF
authors.lastname: de Wolff
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D013956:Antithyroid Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007008:Hypokalemia / Q000175:diagnosis / Q000209:etiology; D020514:Hypokalemic Periodic Paralysis / Q000175:diagnosis / Q000188:drug therapy*; D007262:Infusions, Intravenous; D035002:Lower Extremity; D008297:Male; D008991:Monitoring, Physiologic; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology; D011188:Potassium / Q000008:administration & dosage*; D018570:Risk Assessment; D013971:Thyrotoxicosis / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D011188:Potassium