Thyrotoxic Periodic Paralysis in a 20-Year-Old Nigerian Male

Abstract

Background: Thyrotoxic Periodic Paralysis (TPP) is a rare complication of hyperthyroidism characterised by hypokalaemia and recurrent episodes of muscle weakness. Increased awareness will promote early diagnosis and prompt treatment of the condition. Objective: To highlight an uncommon case of TPP in a Nigerian male with normokalaemia on presentation. Case: A 20-year-old male patient on treatment for hyperthyroidism (Grave’s disease) who was referred to the endocrine clinic on account of recurrent episodes of acute symmetrical painful lower limb muscle weakness. He had experienced a total of 5 episodes approximately 2-3 months apart with each attack lasting between 10-36 h there was a positive history of strenuous activities preceding each attack. Limb pain was relieved by analgesics and weakness resolved spontaneously without any specific medications after 2-3 days. Investigations revealed elevated T3 and T4 (212.3 ng/ml and 18.3 μg/ml respectively), reduced TSH (<0.1 mIU/ ml), low-normal serum potassium (3.6 mmol/L) on presentation and hypokalaemia (2.5 mmol/L) during an episode and hypocalcaemia (2.0 mmol/L). He was placed on 30 mg of carbimazole, propranolol 120 mg in divided doses and low dose oral potassium chloride. He showed remarkable response to treatment with reduction in the frequency of attacks and eventual resolution of symptoms.