DECREMENTAL RESPONSE ON PROLONGED EXERCISE TEST IN A PATIENT WITH THYROTOXIC PERIODIC PARALYSIS
Keywords:Hypokalemic periodic paralysis, electromyography, thyrotoxicosis, nerve conduction
AbstractParalysis of acute onset often presents a diagnostic challenge for the assessing physician because of a large number of differential diagnosis and overlap of clinical features among them. Thyrotoxic periodic paralysis is an uncommon cause of acute weakness. In addition to serological tests, electromyography findings during prolonged exercise test are very helpful in confirming the diagnosis. Only a few case reports of thyrotoxic periodic paralysis have been published from Middle East and none of them have described this specific electrophysiological data. A man in his 20s presented to us with acute onset weakness in both legs which was evaluated further and found to have hypokalemia. The work up for the etiology revealed thyrotoxic status and a final diagnosis of thyrotoxic periodic paralysis was established. The prolonged exercise test performed in this patient showed typical progressive decremental respsonse with nadir at 40 minutes after the exercise.
Chang C-C, Cheng C-J, Sung C-C, Chiueh T-S, Lee C-H, Chau T, et al. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: Focus on symptomatology and precipitants. Europe-an Journal of Endocrinology; 2013. 169:529â€“36.
Bilha S, Mitu O, Teodoriu L, Haba C, Preda C. Thyrotoxic periodic paralysis: A misleading challenge in the emergency department. diagnostics (Basel) [Internet]; 2020 May 18 [cited 2020 Sep 29]. 10(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277936/
Iqbal QZ, Niazi M, Zia Z, Sattar SBA. A literature review on thyrotoxic periodic paralysis. Cureus; 2020. 12(8):e10108. DOI: 10.7759/cureus.10108
Simmons DB, Lanning J, Cleland JC, Puwanant A, Twydell PT, Griggs RC, et al. Long exercise test in periodic paralysis: A bayesian analysis. Muscle & Nerve; 2019. 59(1):47â€“54. DOI: 10.1002/mus.2615
Hakami O, Ahmad MM, Al Johani N. A case of nonfatal ventricular arrhythmia due to thyro-toxic periodic paralysis in a Saudi patient as an initial presentation of Gravesâ€™ disease. Clin Med Insights Case Rep; 2016. 9:5â€“9. DOI: 10.4137/CCRep.S34560
Salih M, Duschek EJJ. Thyrotoxic periodic paralysis: An unusual presentation of hyperthyroidism. The Netherlands Journal of Medicine; 2017. 75(8):6. Avalaible from:
Dilshad Siddiqui. Thyrotoxicosis presenting as hypokalemic periodic paralysis. Bahrain Medical Bulletin; 1998;20(2):58â€“60. Avalaible from: https://www.bahrainmedicalbulletin.com/june_1998/Thyrotoxicosis.pdf
Lin S-H, Huang C-L. Mechanism of thyrotoxic periodic paralysis. J Am Soc Nephrol; 2012. 23:985â€“8. DOI: 10.1681/ASN.2012010046
Kuntzer T, Flocard F, Vial C, Kohler A, Magistris M, Labarre-Vila A, et al. Exercise test in mus-cle channelopathies and other muscle disorders. Muscle & Nerve; 2000. 23:1089â€“94. DOI: 10.1002/1097-4598(200007)23:7<1089::aid-mus12>3.0.co;2-q
Fournier E, Arzel M, Sternberg D, Vicart S, Laforet P, Eymard B, et al. Electromyography guides toward subgroups of mutations in muscle channelopathies. Ann Neurol; 2004;56:650â€“61.
How to Cite
This work is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License