ILLUSTRATIVE CASE
Thyrotoxic Periodic Paralysis in a Pediatric Patient Peter Jones, III, MD, Laura Papadimitropoulos, MD, and Mark O. Tessaro, MD
Abstract: Thyrotoxic periodic paralysis is a reversible metabolic disorder that is characterized by acute muscle weakness and hypokalemia. It predominantly affects males of Asian descent. We describe the youngest such patient yet reported, a 13-year-old Asian male with a history of transient attacks of weakness who presented to our emergency department with weakness in his extremities and mild tachycardia. Laboratory test results initially revealed marked hypokalemia and later confirmed associated hyperthyroidism. Correction of the hypokalemia reversed the patient’s weakness in the emergency department. Key Words: thyrotoxicosis, periodic paralysis, hypokalemia, Asian (Pediatr Emer Care 2014;30: 35Y37)
CASE A 13-year-old male of Asian descent was carried into our emergency department (ED) by his father because he was unable to walk due to weakness. He had no significant past medical history, and his immunizations were up-to-date. There were no recent vaccinations, travel, diet changes, or medical treatments, and he had no known allergies. The patient’s symptoms began 5 hours before presentation, shortly after dinner. He noticed lower extremity weakness that progressed over the course of 15 to 20 minutes to profound weakness. He was carried to bed by his father and went to sleep. Several hours later, he awoke to find that his leg had fallen over the side of his bed, and he was unable to move it or reposition himself. He alerted his parents who brought him to our ED. Further history revealed 2 previous similar episodes at 3 months and 3 weeks before this presentation. Both episodes resolved spontaneously and completely, and no medical attention was sought. On the first occasion, the patient had been unable to rise from a seated position on the floor due to weakness limited to the right leg that lasted approximately half an hour before completely and spontaneously resolving. The second episode occurred while walking, when rapidly progressing bilateral leg weakness forced him to the floor and rendered him unable to rise. This episode lasted approximately 1 hour. There was no history of recent fevers, chills, upper respiratory infection symptoms, malaise, or changes in mental status. There were no heat intolerance, diarrhea, muscle cramps, or sweating. He was a successful eighth-grade student and denied depression or suicidal tendency as well as tobacco, drug, and alcohol use. He also denied sexual activity. On physical examination, the patient was alert and nontoxic appearing. His oral temperature was 37.1-C. His vital signs are as follows: blood pressure, 123/74 mm Hg; heart rate, 104 beats per minute; respiratory rate, 18 breaths per minute; and oxygen saturation, 100% in room air. The cardiac examination result
From the Maimonides Medical Center, Brooklyn, NY. Disclosure: The authors declare no conflict of interest. Reprints: Peter Jones III, MD, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219 (e
Thyrotoxic Periodic Paralysis in a Pediatric Patient Peter Jones, III, MD, Laura Papadimitropoulos, MD, and Mark O. Tessaro, MD
Abstract: Thyrotoxic periodic paralysis is a reversible metabolic disorder that is characterized by acute muscle weakness and hypokalemia. It predominantly affects males of Asian descent. We describe the youngest such patient yet reported, a 13-year-old Asian male with a history of transient attacks of weakness who presented to our emergency department with weakness in his extremities and mild tachycardia. Laboratory test results initially revealed marked hypokalemia and later confirmed associated hyperthyroidism. Correction of the hypokalemia reversed the patient’s weakness in the emergency department. Key Words: thyrotoxicosis, periodic paralysis, hypokalemia, Asian (Pediatr Emer Care 2014;30: 35Y37)
CASE A 13-year-old male of Asian descent was carried into our emergency department (ED) by his father because he was unable to walk due to weakness. He had no significant past medical history, and his immunizations were up-to-date. There were no recent vaccinations, travel, diet changes, or medical treatments, and he had no known allergies. The patient’s symptoms began 5 hours before presentation, shortly after dinner. He noticed lower extremity weakness that progressed over the course of 15 to 20 minutes to profound weakness. He was carried to bed by his father and went to sleep. Several hours later, he awoke to find that his leg had fallen over the side of his bed, and he was unable to move it or reposition himself. He alerted his parents who brought him to our ED. Further history revealed 2 previous similar episodes at 3 months and 3 weeks before this presentation. Both episodes resolved spontaneously and completely, and no medical attention was sought. On the first occasion, the patient had been unable to rise from a seated position on the floor due to weakness limited to the right leg that lasted approximately half an hour before completely and spontaneously resolving. The second episode occurred while walking, when rapidly progressing bilateral leg weakness forced him to the floor and rendered him unable to rise. This episode lasted approximately 1 hour. There was no history of recent fevers, chills, upper respiratory infection symptoms, malaise, or changes in mental status. There were no heat intolerance, diarrhea, muscle cramps, or sweating. He was a successful eighth-grade student and denied depression or suicidal tendency as well as tobacco, drug, and alcohol use. He also denied sexual activity. On physical examination, the patient was alert and nontoxic appearing. His oral temperature was 37.1-C. His vital signs are as follows: blood pressure, 123/74 mm Hg; heart rate, 104 beats per minute; respiratory rate, 18 breaths per minute; and oxygen saturation, 100% in room air. The cardiac examination result
From the Maimonides Medical Center, Brooklyn, NY. Disclosure: The authors declare no conflict of interest. Reprints: Peter Jones III, MD, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219 (e
