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J Korean Soc Emerg Med > Volume 22(5); 2011 > Article
Journal of The Korean Society of Emergency Medicine 2011;22(5): 570-574.
Case of Thyrotoxic Periodic Paralysis Accompanied by Atrioventricular Block Associated with Hypokalemia and Hypophosphatemia
Hyun Soo Kim, Jung Kook Wi, Jung Il So, Moon Chan Choi, Suk Chon, Seungjoon Oh, Jeong taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim
1Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. imdrjs@khu.ac.kr
2Research Institute of Endocrinology, Kyung Hee University School of Medicine, Seoul, Korea.
ABSTRACT
Thyrotoxic periodic paralysis (TPP) occurs in 2% of the asian patients with hyperthyroidism and is characterized by bilateral flaccid paralysis of the extremity, especially lower limbs. It is well-known that hypokalemia is usually accompanied by TPP. However, hypophosphatemia is usually mild and well neglected. Although paralysis is generally recovered without treatment, in some cases, patients with TPP may die due to cardiopulmonary complications, such as cardiac arrhythmia. Therefore, proper and rapid replacement of potassium is essential. But it should be acknowledged that replacement may cause a rebound. TPP is often unrecognized and over-treated in the emergency room due to its non-specific symptoms. This is why clinicians must be familiar with this disease and its diagnostic clues such as Echocardiography change and clinical features. This is a case report of a 29-year-old male presenting with TPP accompanied by hypokalemia, hypophosphatemia and second degree atrioventricular block, who showed rebound hyperkalemia and hyperphosphatemia after rapid replacement of electrolytes. EKG changed to the normal sinus rhythm in the end after the correction of the electrolytes.
Key words: Thyrotoxic periodic paralysis, Hypokalemia, Hypophosphatemia, Second degree AV block
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