Thyrotoxic Periodic Paralysis in the Post-COVID Era: A Case Report with Literature Review

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
C. Gandhi, Mahua Ghosh
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引用次数: 0

Abstract

Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease ha ve been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases
后covid时代甲状腺毒性周期性麻痹1例报告并文献复习
甲状腺毒性周期性麻痹(TPP)是甲状腺功能亢进患者出现突发性肌肉无力和低钾血症的急性潜在致命紧急情况。通常由高碳水化合物或高盐饮食、剧烈运动、压力、创伤、糖皮质激素、肾上腺素、酒精或呼吸道感染引起。COVID-19感染或疫苗接种可能是TPP的新触发因素。此外,COVID-19感染或疫苗接种可引发炎症过程,导致甲状腺毒症,表现为TPP。虽然COVID-19引起亚急性甲状腺炎、甲状腺机能亢进综合征、桥本病或格雷夫斯病已在文献中得到充分记录;covid -19后跨太平洋伙伴关系仅报告了6例病例。值得注意的是,到目前为止,所有病例都仅限于男性患者,并且缺乏来自北美的文献。本文的目的是概述首例COVID-19后TPP的女性患者,她在COVID-19感染三个月后以急性瘫痪和严重低血钾(2.2 mmol/L)就诊于急诊科。急诊检查显示为甲状腺毒症。她接受了钾替代治疗,这改善了她的瘫痪。随后的调查显示格雷夫斯病引起的严重甲亢,目前使用美托洛尔和甲巯咪唑治疗。她的甲状腺功能亢进得到改善,无复发性低血钾或瘫痪。此外,我们概述了TPP的流行病学、病理生理学、诱发因素和管理,特别侧重于COVID-19感染或疫苗接种诱发TPP。我们讨论到目前为止在文献中描述的covid -19后TPP病例。知道北美的COVID-19感染浪潮落后于亚洲,我们可以预测未来会有更多的TPP病例
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来源期刊
Canadian Journal of Rural Medicine
Canadian Journal of Rural Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
1.70
自引率
18.20%
发文量
38
期刊介绍: The Canadian Journal of Rural Medicine (CJRM) is a quarterly peer-reviewed journal available in print form and on the Internet. It is the first rural medical journal in the world indexed in Index Medicus, as well as MEDLINE/PubMed databases. CJRM seeks to promote research into rural health issues, promote the health of rural and remote communities, support and inform rural practitioners, provide a forum for debate and discussion of rural medicine, provide practical clinical information to rural practitioners and influence rural health policy by publishing articles that inform decision-makers.
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