Thyrotoxic periodic paralysis together with thyrotoxic heart disease in a Ghanaian man: case report and literature review

Gordon Manu Amponsah; Yaw Adu-Boakye; Maureen Nyarko; Henry Kofi Andoh; Kwaku Gyasi Danso; Manolo Agbenoku; Isaac Kofi Owusu; Gordon Manu Amponsah; Yaw Adu-Boakye; Maureen Nyarko; Henry Kofi Andoh; Kwaku Gyasi Danso; Manolo Agbenoku; Isaac Kofi Owusu

doi:10.3934/medsci.2023005

AIMS Medical Science

2023, Volume 10, Issue 1: 46-54. doi: 10.3934/medsci.2023005

Previous Article Next Article

Case report Topical Sections

Thyrotoxic periodic paralysis together with thyrotoxic heart disease in a Ghanaian man: case report and literature review

1.
Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
2.
Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumai, Ghana
3.
Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Received: 22 January 2023 Revised: 28 February 2023 Accepted: 06 March 2023 Published: 15 March 2023

Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diagnosis and treatment which can prevent complications.
- thyrotoxic,
- periodic,
- paralysis,
- hypokalemia,
- case report
Citation: Gordon Manu Amponsah, Yaw Adu-Boakye, Maureen Nyarko, Henry Kofi Andoh, Kwaku Gyasi Danso, Manolo Agbenoku, Isaac Kofi Owusu. Thyrotoxic periodic paralysis together with thyrotoxic heart disease in a Ghanaian man: case report and literature review[J]. AIMS Medical Science, 2023, 10(1): 46-54. doi: 10.3934/medsci.2023005

Related Papers:

Abstract

Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diagnosis and treatment which can prevent complications.

Ethical approval

Patient gave written informed consent for publication of this case report. The case report including the electrocardiogram and echocardiogram images were de-identified to protect patient's privacy and maintain confidentiality.

Conflict of interest

All authors declare no conflicts of interest in this paper.

References

[1]	Kung AWC (2006) Thyrotoxic periodic paralysis: A diagnostic challenge. J Clin Endocrinol Metab 91: 2490-2495. https://doi.org/10.1210/JC.2006-0356
[2]	Taylor PN, Albrecht D, Scholz A, et al. (2018) Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 14: 301-316. https://doi.org/10.1038/nrendo.2018.18
[3]	Sarfo-Kantanka O, Sarfo FS, Ansah EO, et al. (2017) Spectrum of endocrine disorders in central Ghana. Int J Endocrinol 2017: 5470731. https://doi.org/10.1155/2017/5470731
[4]	Falhammar H, Thorén M, Calissendorff J (2013) Thyrotoxic periodic paralysis: clinical and molecular aspects. Endocrine 43: 274-284. https://doi.org/10.1007/s12020-012-9777-x
[5]	Kelley DE, Gharib H, Kennedy FP, et al. (1989) Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Intern Med 149: 2597-2600. https://doi.org/10.1001/archinte.149.11.2597
[6]	McFadzean AJ, Yeung R (1967) Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1: 451-455. https://doi.org/10.1136/bmj.1.5538.451
[7]	Okinaka S, Shizume K, Iino S, et al. (1957) The association of periodic paralysis and hyperthyroidism in Japan. J Clin Endocrinol Metab 17: 1454-1459. https://doi.org/10.1210/jcem-17-12-1454
[8]	Tessier JJ, Neu SK, Horning KK (2010) Thyrotoxic periodic paralysis (TPP) in a 28-year-old Sudanese man started on prednisone. J Am Board Fam Med 23: 551-554. https://doi.org/10.3122/jabfm.2010.04.090220
[9]	Manoukian MA, Foote JA, Crapo LM (1999) Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med 159: 601-606. https://doi.org/10.1001/archinte.159.6.601
[10]	Siddamreddy S, Dandu VH (2022) Thyrotoxic periodic paralysis.StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560670/
[11]	Glass J, Osipoff J (2020) Thyrotoxic periodic paralysis presenting in an African-American teenage male: case report. Int J Pediatr Endocrinol 2020: 7. https://doi.org/10.1186/s13633-020-00077-3
[12]	Chatot-Henry C, Smadja D, Longhi R, et al. (2000) Thyrotoxic periodic paralysis. Two news cases in black race patients. Rev Med Interne 21: 632-634. (Article in French) https://doi.org/10.1016/S0248-8663(00)80010-7
[13]	Iheonunekwu NC, Ibrahim TM, Davies D, et al. (2004) Thyrotoxic hypokalaemic paralysis in a pregnant Afro-Carribean woman: A case report and review of the literature. West Indian Med J 53: 47-49.
[14]	Ngonyani M, Manji H (2021) Thyrotoxicosis: an unusual cause of periodic paralysis (a case report from Tanzania). PAMJ Clin Med 7. https://doi.org/10.11604/pamj-cm.2021.7.24.31614
[15]	Sow M, Diagne N, Djiba B, et al. (2020) Thyrotoxic hypokalemic periodic paralysis in two African black women. Pan Afr Med J 37: 207. (Article in French) https://doi.org/10.11604/pamj.2020.37.207.24900
[16]	Schoumaker V, Bovy P (2013) Clinical case of the month. Thyrotoxic periodic paralysis. Report of a case in a Somalian male. Rev Med Liege 68: 402-407. (Article in French)
[17]	Fontaine B (2008) Periodic paralysis. Adv Genet 63: 3-23. https://doi.org/10.1016/s0065-2660(08)01001-8
[18]	Venance SL, Cannon SC, Fialho D, et al. (2006) The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain 129: 8-17. https://doi.org/10.1093/brain/awh639
[19]	Ptáček LJ, Tawil R, Griggs RC, et al. (1994) Dihydropyridine receptor mutations cause hypokalemic periodic paralysis. Cell 77: 863-868. https://doi.org/10.1016/0092-8674(94)90135-x
[20]	Fouad G, Dalakas M, Servidei S, et al. (1997) Genotype-phenotype correlations of DHP receptor α1-subunit gene mutations causing hypokalemic periodic paralysis. Neuromuscul Disord 7: 33-38. https://doi.org/10.1016/s0960-8966(96)00401-4
[21]	Jurkat-rott K, Lehmann-horn F, Elbaz A, et al. (1994) A calcium channel mutation causing hypokalemic periodic paralysis. Hum Mol Genet 3: 1415-1419. https://doi.org/10.1093/hmg/3.8.1415
[22]	Sternberg D, Maisonobe T, Jurkat-Rott K, et al. (2001) Hypokalaemic periodic paralysis type 2 caused by mutations at codon 672 in the muscle sodium channel gene SCN4A. Brain 124: 1091-1099. https://doi.org/10.1093/brain/124.6.1091
[23]	Bulman DE, Scoggan KA, Van Oene MD, et al. (1999) A novel sodium channel mutation in a family with hypokalemic periodic paralysis. Neurology 53: 1932-1936. https://doi.org/10.1212/wnl.53.9.1932
[24]	Jurkat-Rott K, Mitrovic N, Hang C, et al. (2000) Voltage-sensor sodium channel mutations cause hypokalemic periodic paralysis type 2 by enhanced inactivation and reduced current. Proc Natl Acad Sci U S A 97: 9549-9554. https://doi.org/10.1073/pnas.97.17.9549
[25]	Zhao SX, Liu W, Liang J, et al. (2019) Assessment of molecular subtypes in thyrotoxic periodic paralysis and Graves disease among Chinese Han adults: A population-based genome-wide association study. JAMA Netw open 2: e193348. https://doi.org/10.1001/jamanetworkopen.2019.3348
[26]	Li GHY, Cheung CL, Zhao SX, et al. (2020) Genome-wide meta-analysis reveals novel susceptibility loci for thyrotoxic periodic paralysis. Eur J Endocrinol 183: 607-617. https://doi.org/10.1530/EJE-20-0523
[27]	Park S, Kim TY, Sim S, et al. (2017) Association of KCNJ2 genetic variants with susceptibility to thyrotoxic periodic paralysis in patients with Graves' disease. Exp Clin Endocrinol Diabetes 125: 75-78. https://doi.org/10.1055/s-0042-119527
[28]	Cheung CL, Lau KS, Ho AYY, et al. (2012) Genome-wide association study identifies a susceptibility locus for thyrotoxic periodic paralysis at 17q24.3. Nat Genet 44: 1026-1029. https://doi.org/10.1038/ng.2367
[29]	Hsu YJ, Lin YF, Chau T, et al. (2003) Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis. Am J Med Sci 326: 128-132. https://doi.org/10.1097/00000441-200309000-00004
[30]	Fisher J (1982) Thyrotoxic periodic paralysis with ventricular fibrillation. Arch Intern Med 142: 1362-1364. https://doi.org/10.1001/archinte.1982.00340200130024
[31]	Pompeo A, Nepa A, Maddestra M, et al. (2007) Thyrotoxic hypokalemic periodic paralysis: An overlooked pathology in western countries. Eur J Intern Med 18: 380-390. https://doi.org/10.1016/j.ejim.2007.03.003
[32]	Talbott JH (1941) Periodic paralysis. Medicine 20: 85-143.
[33]	Schmidt ST, Ditting T, Deutsch B, et al. (2015) Circadian rhythm and day to day variability of serum potassium concentration: a pilot study. J Nephrol 28: 165-172. https://doi.org/10.1007/s40620-014-0115-7
[34]	Gumz ML, Rabinowitz L (2013) Role of circadian rhythms in potassium homeostasis. Semin Nephrol 33: 229-236. https://doi.org/10.1016/j.semnephrol.2013.04.003
[35]	Edelman J, Stewart-Wynne EG (1981) Respiratory and bulbar paralysis with relapsing hyperthyroidism. Br Med J 283: 275-276. https://doi.org/10.1136/bmj.283.6286.275-a
[36]	Lam L, Nair RJ, Tingle L (2006) Thyrotoxic periodic paralysis. Proc 19: 126-129. https://doi.org/10.1080/08998280.2006.11928143
[37]	Tella SH, Kommalapati A (2015) Thyrotoxic periodic paralysis: An underdiagnosed and under-recognized condition. Cureus 7: e342. https://doi.org/10.7759/cureus.342

Reader Comments

Your name:*

Email:*
© 2023 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)