SHM Converge Scientific Abstract ePoster Gallery-Thyrotoxic Periodic Paralysis: The Still Before the Thyroid Storm

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This case report describes a 20-year-old man with no significant past medical history who presented to the emergency department with rapidly progressive bilateral leg weakness that advanced to flaccid paralysis within hours. He was found to have severe hypokalemia and was diagnosed with thyrotoxic periodic paralysis (TPP) due to previously unrecognized hyperthyroidism.<br /><br />During evaluation, his ECG revealed ventricular tachycardia that progressed to ventricular fibrillation, requiring three defibrillations and resuscitation. After return of spontaneous circulation, he was intubated and treated with potassium replacement. Thyroid studies later showed marked thyrotoxicosis (suppressed TSH with elevated T3 and T4), and he was started on propylthiouracil, dexamethasone, and propranolol as tolerated. His electrolyte abnormalities resolved and strength returned, but he later developed acute neurologic decline with hemiparesis from a left M2 MCA occlusion. Imaging showed ischemic stroke with hemorrhagic transformation and cerebral edema, ultimately requiring emergent decompressive craniotomy. Despite intervention, he suffered permanent neurologic disability.<br /><br />The report highlights key clinical features of TPP, including acute proximal weakness, preserved consciousness, severe hypokalemia, and ECG abnormalities such as arrhythmias. It also emphasizes treatment pitfalls, particularly rebound hyperkalemia after potassium repletion. In addition, the authors discuss the association between hyperthyroidism and hypercoagulability, including decreased fibrinolysis and increased von Willebrand factor, which may have contributed to the patient’s stroke risk.<br /><br />Overall, this case underscores that TPP should be considered in young patients with sudden paralysis and electrolyte abnormalities, and that hyperthyroid-related hypercoagulability may create serious thromboembolic risk, especially in critically ill patients.

Asset Subtitle

Ginearosa Carbone

Meta Tag

Author List Ginearosa Carbone, Mony Son

Category Clinical Vignettes

Concept Thyrotoxic Periodic Paralysis

Concept Muscle Weakness

Concept Hypokalemia

Concept Potassium Repletion

Concept Hyperthyroidism

Distinguished Non-Finalist

Presenter Organization Santa Barbara Cottage Hospital

Presenting Author Ginearosa Carbone

Track Adult

Keywords

thyrotoxic periodic paralysis

hypokalemia

hyperthyroidism

ventricular tachycardia

ventricular fibrillation

thyrotoxicosis

ischemic stroke

hemiparesis

hypercoagulability

decompressive craniotomy

Thyrotoxic Periodic Paralysis

Muscle Weakness

Hypokalemia

Potassium Repletion

Hyperthyroidism