scholarly journals Rhabdomyolysis Induced by Nonstrenuous Exercise in a Patient with Graves’ Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Sarawut Summachiwakij ◽  
Issac Sachmechi
Keyword(s):  
Differential Diagnosis ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Past Medical History ◽  
Thyrotoxic Periodic Paralysis ◽  
Radioiodine Uptake ◽  
Thyroid Stimulating Immunoglobulins ◽  
History Of ◽  
Brown Urine ◽  
Thyroid Ophthalmopathy

Hyperthyroidism can result in several musculoskeletal conditions such as thyrotoxic periodic paralysis, thyrotoxic myopathy, and thyroid ophthalmopathy. Rhabdomyolysis has been rarely reported to be associated with hyperthyroidism. We describe a 33-year-old man who presented with bilateral thigh pain and dark brown urine after regular squatting. He had a past medical history of hyperthyroidism but stopped taking it 2 months prior to admission. He was found to have rhabdomyolysis, myoglobinuria, and thyrotoxicosis. Presence of thyroid-stimulating immunoglobulins (TSI) and high radioiodine uptake confirmed a diagnosis of Graves' disease. He received aggressive fluid resuscitation and sodium bicarbonate intravenously along with monitoring fluid and electrolyte. Methimazole was also resumed. The patient responded to treatment and rhabdomyolysis gradually resolved. Therefore, nonstrenuous exercise can potentially induce rhabdomyolysis in patients with hyperthyroidism. Although hyperthyroidism is not widely recognized as a cause of rhabdomyolysis, it should be considered in the differential diagnosis of rhabdomyolysis.

scholarly journals SUN-496 A Challenging Diagnosis of Thyrotoxic Periodic Paralysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gabriela Mroueh ◽  
Ramachandra Rahul V Chemitiganti
Keyword(s):  
Drug Abuse ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Recreational Drug ◽  
Muscular Weakness ◽  
Laboratory Studies ◽  
Inherited Disorders ◽  
Thyrotoxic Periodic Paralysis ◽  
Lower Extremity Weakness ◽  
History Of

Abstract Thyrotoxic Periodic Paralysis (TPP) is a rare but potentially lethal manifestation of hyperthyroidism which is characterized by muscular weakness due to intracellular shift of potassium and subsequent hypokalemia. The muscular weakness may range from mild weakness to complete flaccid paralysis. It is predominantly seen in Asian young men. Graves’ disease has been described as the most common cause of TPP. Other rare causes of hypokalemic periodic paralysis include inherited disorders and acquired cases due to drug abuse, specifically cocaine. It is important to recognize and diagnose TPP to provide appropriate treatment and prevent serious cardiopulmonary complications. A 26 year old Hispanic male with past medical history of cocaine abuse presented to the emergency department with profound lower extremity weakness since that morning. Laboratory studies on initial evaluation revealed hypokalemia. He was admitted to the intensive care unit (ICU) for IV potassium replacement and cardiac monitoring. Upon obtaining further history, the patient had suffered a similar episode of weakness and hypokalemia two months prior. At the time, he had a positive urine toxicology for cocaine. He was treated with IV potassium with resolution of his weakness and was told the reason for the episode was cocaine induced periodic paralysis. No further work up was done due to patient leaving Against Medical Advice. The patient stopped recreational drug abuse after this diagnosis. During current hospitalization, further laboratory studies revealed hyperthyroidism. TSI and TPO antibodies were elevated and thus patient was diagnosed with Graves’ disease. On questioning, patient was asymptomatic and clinically euthyroid. He was treated with IV potassium, methimazole and propranolol with quick resolution of weakness. He has been followed in an out-patient basis and he has had no further exacerbations. In this case, we present a case of TPP that was initially diagnosed as cocaine induced periodic paralysis which is an extremely rare disorder with only a couple of described cases in the literature. Diagnosis was initially missed as the patient was clinically euthyroid and had history of recreational drug abuse. Restoration of euthyroidism eliminates attacks of TPP. It is important to recognize and diagnose these patient to prevent further attacks.

Neonatal Hyperthyroidism m Infants of Mothers Previously Thyroidectomized due to Graves’ Disease

2001 ◽  
Vol 14 (8) ◽  
Author(s):  
Maria Victoria Borras-Perez ◽  
David Moreno-Pérez ◽  
Amalia Zuasnabar-Cotro ◽  
Juan P. López-Siguero
Keyword(s):  
Total Thyroidectomy ◽  
Radioiodine Therapy ◽  
Graves Disease ◽  
Transplacental Passage ◽  
The Third ◽  
Thyroid Stimulating Immunoglobulins ◽  
Thyroid Ablation ◽  
Neonatal Hyperthyroidism ◽  
History Of

AbstractNeonatal hyperthyroidism generally arises as a result of active maternal Graves’ disease via transplacental passage of thyroid stimulating immunoglobulins (TSI). On occasions, production of these antibodies may continue after thyroid ablation, either surgically or with radioiodine therapy. We present data concerning three patients (two of them twins) whose mothers had previously undergone near-total thyroidectomy prior to conception. Two of the neonates had neonatal hyperthyroidism due to persistence of TSI in the mother, and the third due to relapse of the maternal Graves’ disease during pregnancy. We recommend monitoring TSI during pregnancy in mothers with a history of Graves’ disease, even if they are in a state of post-surgical hypothyroidism.

scholarly journals Thyrotoxic periodic paralysis in new-onset hyperthyroidism – a case report and review of the literature

2014 ◽  
Vol 12 (4) ◽  
pp. 531
Author(s):  
Joaquim Custódio da Silva Junior ◽  
Helton Estrela Ramos
Keyword(s):  
Case Report ◽  
Previous History ◽  
Rare Condition ◽  
Periodic Paralysis ◽  
Emergency Physicians ◽  
Review Of The Literature ◽  
Font Size ◽  
Thyrotoxic Periodic Paralysis ◽  
History Of ◽  
New Onset

<p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><em><span style="font-size: 10.0pt; font-family: ";Times New Roman";,";serif";; mso-ansi-language: EN-US;" lang="EN-US">Thyrotoxic periodic paralysis (TPP) is a rare condition related to hyperthyroidism, with specific clinical and physiopathological features. In this article, we discuss a case report of a patient that develops TPP with no previous history of thyroid illness, highlighting semiological characteristics that can help Emergency physicians to suspect of this condition. Subsequently, we review the recent articles about TPP, with focus in the molecular basis of ion channelopathies and predisposing factors, and discuss the therapeutic approach at acute phase of TPP and prevention of crisis recurrence.</span></em></p>

scholarly journals Thyrotoxic Periodic Paralysis and Cardiomyopathy in a Patient with Graves’ Disease

Cureus ◽  
2018 ◽  
Author(s):  
Anna A Abbasi ◽  
Prarthna Chandar ◽  
Shyam Shankar ◽  
Sushilkumar S Gupta ◽  
Yizhak Kupfer
Keyword(s):  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis

scholarly journals A Case of Nonfatal Ventricular Arrhythmia Due to Thyrotoxic Periodic Paralysis in a Saudi Patient as an Initial Presentation of Graves’ Disease

2016 ◽  
Vol 9 ◽  
pp. CCRep.S34560 ◽  
Author(s):  
Osamah Hakami ◽  
Maswood M. Ahmad ◽  
Naji Al Johani
Keyword(s):  
Muscle Weakness ◽  
Early Recognition ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Populations ◽  
Definitive Therapy ◽  
Life Threatening ◽  
Acute Paraparesis ◽  
Saudi Male

Thyrotoxic periodic paralysis (TPP) is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. It has been commonly reported in non-Asian populations. Four cases were reported in Saudis so far, and one had a life-threatening arrhythmia. We describe an additional case of a 28-year-old apparently healthy Saudi male patient, who presented with acute paraparesis associated with hypokalemia (K: 2.0 mmol/L), complicated by ventricular tachycardia and cardiac arrest. He was successfully resuscitated and his hypokalemia was corrected. A diagnosis of Graves’ disease associated with TPP was made. He was initially treated with carbimazole and β-blockers and then given a definitive therapy with radioactive iodine, which showed a good response. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness. A brief review of TPP and associated arrhythmia is included.

scholarly journals Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease

2016 ◽  
Vol 31 (1) ◽  
pp. 142 ◽  
Author(s):  
Suyeon Park ◽  
Tae Yong Kim ◽  
Soyoung Sim ◽  
Seonhee Lim ◽  
Mijin Kim ◽  
...  
Keyword(s):  
Periodic Paralysis ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis

scholarly journals Contribution of Asian Haplotype of KCNJ18 to Susceptibility to and Ethnic Differences in Thyrotoxic Periodic Paralysis

2019 ◽  
Vol 104 (12) ◽  
pp. 6338-6344
Author(s):  
Shinsuke Noso ◽  
Naru Babaya ◽  
Yoshihisa Hiromine ◽  
Hiroyuki Ito ◽  
Yasunori Taketomo ◽  
...  
Keyword(s):  
Direct Sequencing ◽  
East Asian ◽  
Japanese Patients ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Strong Linkage Disequilibrium ◽  
Single Nucleotide Variants ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Populations ◽  
Haplotype 1

Abstract Context and Objectives Thyrotoxic periodic paralysis (TPP) is an acute complication of thyrotoxicosis that can be lethal. TPP is rare in Caucasians but often affects young men in East Asian populations. This study aimed to clarify the contribution of KCNJ18 to susceptibility to TPP in East Asian populations. Participants and Methods The study comprised 635 participants including 13 Japanese patients with TPP, 208 Japanese patients with Graves disease without TPP, and 414 healthy control subjects from the Japanese (n = 208), Korean (n = 111), and Caucasian populations (n = 95). DNA samples from 29 participants (13 with TPP, 8 with Graves disease, and 8 controls) were sequenced for KCNJ18, and all participants (n = 635) were genotyped for six variants of KCNJ18 and a polymorphism of KCNJ2 (rs312691). Results Six single-nucleotide variants (SNVs) with amino acid substitutions were identified by direct sequencing of KCNJ18. Among these, four SNVs comprised three haplotypes under strong linkage disequilibrium. Haplotype 1 (AAAG) of KCNJ18 was significantly associated with susceptibility to TPP in the Japanese population (OR = 19.6; 95% CI, 1.5 to 256.9; P = 0.013). Haplotype frequencies in the general East Asian (Japanese and Korean) and Caucasian populations differed significantly (haplotype 1: 80.8% vs 48.4%, P = 1.1×10−27). Conclusion A major haplotype of KCNJ18 in East Asian populations is significantly associated with susceptibility to TPP. The haplotype is much more common in East Asian than Caucasian populations, suggesting its contribution to the high prevalence of TPP in East Asian populations.

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