Glucocorticoid Induced Hypokalemic Periodic Paralysis in Subclinical Hyperthyroidism: Case Report / Glukokortikoid Kullanımına Bağlı Hipokalemik Periyodik Paralizi Gelişen Subklinik Hipertiroidizm Olgusu

Dilek Gibyeli Genek, Bülent Huddam, Volkan Karakuş, Birdal Yıldırım, Okşan Uyar Gazezoğlu

Özet


Abstract

Thyrotoxic periodic paralysis (TPP), the most commonly seen disorder among Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The underlying hyperthyroidism is often subtle, which causes difficulty in early diagnosis. Factors such as high-carbohydrate eating habit, excessive exercise, use of steroid, and stress can precipitate a TPP attack. We, hereby, present a young Turkish man who developed acute paralysis after receiving intravenously applied dexamethasone for weever fish poisoning. His serum potassium level was 2.3 mmol/l. Moreover, he had subclinical hyperthyroidism and elevated serum creatinephosphokinase (CPK: 609 U/L) and hypophosphatemia (p:1.8 mg/dl). He had neither a loss of renal (24 h urinary potassium: 19.9 mmol) nor gastrointestinal potassium. His muscle strength and serum potassium were fully recovered after a small amount of potassium replacement. The patient was diagnosed as Steroid induced TPP in subclinical hyperthyroidism and was treated with nonselective beta blockers to prevent the possible attacks. In conclusion, we deduced that Steroid induced TPP may develop even in the presence of subclinical hyperthyroidism. We want to share our experience on this issue to raise awareness.

Keywords: Hypokalemia, Periodic Paralysis, Steroid, Hyperthyroidism

Özet

Tirotoksik periodic paralizi (TPP) çoğunlukla asyalı genç erkeklerde görülen, ani başlayan, hipokalemi ve paralizi ile karakterize bir hastalıktır. Altta yatan hipertiroidizm sıklıkla belirgin olmayıp erken tanı koymak zordur. Aşırı karbonhidrat alımı, aşırı egzersiz, steroid kullanımı ve stress gibi etkenler TPP atağını tetikleyebilir. Biz, bu olguda balık sokması (weever fish) nedeni ile intravenöz deksametazon uygulandıktan sonra akut paralizi gelişen genç erkek hastayı sunduk. Hastanın serum potasyum düzeyi (2.3 mmol/l) ve fosfor düzeyi (1.8 mmol/l) düşük , keratin kinaz düzeyi (609 U/l) yüksekti. Hastada subklinik hipertiroidi saptandı. Renal (24 saat idrar potasyum düzeyi 19.9 mmol/l) ve gastrointestinal potasyum kaybı yoktu. Hastaya tirotoksik hipokalemik periyodik paralizi tanısı kondu. Tedavide akut atakları önlemek üzere nonselektif beta bloker başlandı. Olgumuzu; subklinik hipertiroidi varlığında bile steroid ile TPP atağının tetiklenebileceğine dair farkındalık sağlamak üzere sunmak istedik.

Anahtar Kelimeler: Hipokalemi, Periyodik Paralizi, Steroid, Hipertiroidizm

 


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