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Medical Student
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Internal Medicine
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Internal Medicine
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Patient Care
Abstract Type
Case Report
Abstract
Background: Thyrotoxic periodic paralysis (TPP) is a rare and potentially life-threatening complication of hyperthyroidism, typically affecting adult males of Asian descent. Excess thyroid hormone increases Na+/K+-ATPase activity in skeletal muscle, resulting in a sudden and profound intracellular shift of potassium that leads to acute muscle weakness. Although uncommon in other populations, early recognition of TPP in atypical demographics is crucial to prevent serious complications such as cardiac arrhythmias. Simple, albeit careful, management for these patients includes IV or oral potassium supplementation with nonselective beta-blockers, which rapidly improves patients' clinical status and resolves hypokalemia. Definitive therapy/prevention of TTP is maintaining a euthyroid state by adhering to antithyroid medications (i.e., methimazole). We present this case due to its clinical relevance and educational value for clinicians and medical trainees.
Case Presentation: A 35-year-old Hispanic male with a past medical history of Graves' disease presented with acute bilateral lower extremity weakness that started in the early morning. He confirmed having experienced similar episodes in the past but denied any known precipitating factors associated with current symptoms. Upon presentation, he was hemodynamically stable (afebrile, normotensive, heart rate within normal limits); however, he had a potassium level of 2.5 mmol/L and a suppressed TSH level (< 0.005 mIU/L). Thyroid autoantibodies were also remarkably elevated. Neurological exam showed noticeably decreased bilateral lower extremity strength with the inability to stand or ambulate, however, without sensory deficits. ECG revealed sinus bradycardia and T-wave inversions. The patient was admitted, treated with cautious IV potassium repletion, and maintained on methimazole and propranolol. He remained stable throughout hospitalization, and his weakness resolved as potassium levels normalized. Prior to discharge, endocrinology was consulted for long-term management.
Conclusions: This case demonstrates a textbook presentation of TPP in a young non-Asian male, highlighting the importance of clinical vigilance in patient populations that differ from the most typically associated population. The Rio Grande Valley has a total Asian population of only ~1.2% which is why clinicians in this region and similar areas should maintain a high clinical suspicion for this clinical condition. Patients have an excellent prognosis if clinicians demonstrate early recognition, cautious potassium repletion, and restoration or initiation of nonselective beta-blockers. Of course, patient education on medication adherence with an emphasis on primary care and endocrinology follow-up is most important to maintaining a euthyroid state, which prevents this condition from ultimately developing.
Presentation Type
Poster
Recommended Citation
Garcia, Stephen M.; Martinez Meza, Ruben; Bangash, Aun A.; Martin, Blake C.; and Campo Maldonado, Jose, "Thyrotoxic Periodic Paralysis in a Non-Asian Male: A Case Report" (2025). Research Colloquium. 103.
https://scholarworks.utrgv.edu/colloquium/2025/posters/103
Included in
Thyrotoxic Periodic Paralysis in a Non-Asian Male: A Case Report
Background: Thyrotoxic periodic paralysis (TPP) is a rare and potentially life-threatening complication of hyperthyroidism, typically affecting adult males of Asian descent. Excess thyroid hormone increases Na+/K+-ATPase activity in skeletal muscle, resulting in a sudden and profound intracellular shift of potassium that leads to acute muscle weakness. Although uncommon in other populations, early recognition of TPP in atypical demographics is crucial to prevent serious complications such as cardiac arrhythmias. Simple, albeit careful, management for these patients includes IV or oral potassium supplementation with nonselective beta-blockers, which rapidly improves patients' clinical status and resolves hypokalemia. Definitive therapy/prevention of TTP is maintaining a euthyroid state by adhering to antithyroid medications (i.e., methimazole). We present this case due to its clinical relevance and educational value for clinicians and medical trainees.
Case Presentation: A 35-year-old Hispanic male with a past medical history of Graves' disease presented with acute bilateral lower extremity weakness that started in the early morning. He confirmed having experienced similar episodes in the past but denied any known precipitating factors associated with current symptoms. Upon presentation, he was hemodynamically stable (afebrile, normotensive, heart rate within normal limits); however, he had a potassium level of 2.5 mmol/L and a suppressed TSH level (< 0.005 mIU/L). Thyroid autoantibodies were also remarkably elevated. Neurological exam showed noticeably decreased bilateral lower extremity strength with the inability to stand or ambulate, however, without sensory deficits. ECG revealed sinus bradycardia and T-wave inversions. The patient was admitted, treated with cautious IV potassium repletion, and maintained on methimazole and propranolol. He remained stable throughout hospitalization, and his weakness resolved as potassium levels normalized. Prior to discharge, endocrinology was consulted for long-term management.
Conclusions: This case demonstrates a textbook presentation of TPP in a young non-Asian male, highlighting the importance of clinical vigilance in patient populations that differ from the most typically associated population. The Rio Grande Valley has a total Asian population of only ~1.2% which is why clinicians in this region and similar areas should maintain a high clinical suspicion for this clinical condition. Patients have an excellent prognosis if clinicians demonstrate early recognition, cautious potassium repletion, and restoration or initiation of nonselective beta-blockers. Of course, patient education on medication adherence with an emphasis on primary care and endocrinology follow-up is most important to maintaining a euthyroid state, which prevents this condition from ultimately developing.
