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KMID : 0385920110220050570
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Journal of the Korean Society of Emergency Medicine
2011 Volume.22 No. 5 p.570 ~ p.574
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Case of Thyrotoxic Periodic Paralysis Accompanied by Atrioventricular Block Associated with Hypokalemia and Hypophosphatemia
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Kim Hyun-Soo
Wi Jung-Kook
Son Jung-Il
Choi Moon-Chan
Chon Suk
Oh Seung-Joon
Woo Jeong-Taek
Kim Sung-Woon
Kim Jin-Woo
Kim Young-Seol
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Abstract
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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.
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KEYWORD
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Thyrotoxic periodic paralysis, Hypokalemia, Hypophosphatemia, Second degree AV block
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