Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man.

Abstract

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

• Authors: M A Al-Jubouri, G D Inkster, P A Nee, F J Andrews
• Journal: Annals of clinical biochemistry (Ann Clin Biochem) Vol. 43 Issue Pt 4 Pg. 323-5 (Jul 2006) ISSN: 0004-5632 [Print] England
• PMID: 16824287 (Publication Type: Case Reports, Journal Article)

Chemical References

• Phosphates
• Propranolol
• Potassium

Topics

• Administration, Oral
• Adult
• Asian People
• Diagnosis, Differential
• Humans
• Hypokalemic Periodic Paralysis (complications, diagnosis, ethnology)
• Malaysia
• Male
• Phosphates (therapeutic use)
• Potassium (therapeutic use)
• Propranolol (administration & dosage)
• Thyrotoxicosis (complications, diagnosis, ethnology)