Glucocorticoid Induced Hypokalemic Periodic Paralysis in Subclinical Hyperthyroidism: Case Report / Glukokortikoid Kullanımına Bağlı Hipokalemik Periyodik Paralizi Gelişen Subklinik Hipertiroidizm Olgusu

Abstract Thyrotoxic periodic paralysis (TPP), the most commonly seen disorder among Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The underlying hyperthyroidism is often subtle, which causes difficulty in early diagnosis. Factors such as high-carbohydrate eating habit, excessive exercise, use of steroid, and stress can precipitate a TPP attack. We, hereby, present a young Turkish man who developed acute paralysis after receiving intravenously applied dexamethasone for weever fish poisoning. His serum potassium level was 2.3 mmol/l. Moreover, he had subclinical hyperthyroidism and elevated serum creatinephosphokinase (CPK: 609 U/L) and hypophosphatemia (p:1.8 mg/dl). He had neither a loss of renal (24 h urinary potassium: 19.9 mmol) nor gastrointestinal potassium. His muscle strength and serum potassium were fully recovered after a small amount of potassium replacement. The patient was diagnosed as Steroid induced TPP in subclinical hyperthyroidism and was treated with nonselective beta blockers to prevent the possible attacks. In conclusion, we deduced that Steroid induced TPP may develop even in the presence of subclinical hyperthyroidism. We want to share our experience on this issue to raise awareness. Keywords: Hypokalemia, Periodic Paralysis, Steroid, Hyperthyroidism Ozet Tirotoksik periodic paralizi (TPP) cogunlukla asyali genc erkeklerde gorulen, ani baslayan, hipokalemi ve paralizi ile karakterize bir hastaliktir. Altta yatan hipertiroidizm siklikla belirgin olmayip erken tani koymak zordur. Asiri karbonhidrat alimi, asiri egzersiz, steroid kullanimi ve stress gibi etkenler TPP atagini tetikleyebilir. Biz, bu olguda balik sokmasi (weever fish) nedeni ile intravenoz deksametazon uygulandiktan sonra akut paralizi gelisen genc erkek hastayi sunduk. Hastanin serum potasyum duzeyi (2.3 mmol/l) ve fosfor duzeyi (1.8 mmol/l) dusuk , keratin kinaz duzeyi (609 U/l) yuksekti. Hastada subklinik hipertiroidi saptandi. Renal (24 saat idrar potasyum duzeyi 19.9 mmol/l) ve gastrointestinal potasyum kaybi yoktu. Hastaya tirotoksik hipokalemik periyodik paralizi tanisi kondu. Tedavide akut ataklari onlemek uzere nonselektif beta bloker baslandi. Olgumuzu; subklinik hipertiroidi varliginda bile steroid ile TPP ataginin tetiklenebilecegine dair farkindalik saglamak uzere sunmak istedik. Anahtar Kelimeler: Hipokalemi, Periyodik Paralizi, Steroid, Hipertiroidizm