This is a 46-year-old male patient with no history of interest, who comes to consultation for sudden loss of strength in the lower limbs.
This picture is repeatedly and episodic, self-limiting in a few hours.
It usually affects the lower limbs, but can do so in a generalized way.
She suffered previous episodes that increased in frequency and intensity in the last year.
During the directed interview, the patient reported loss of 20 kilos in the last four months, with no decrease in intake, occasional tremor, irritability and nervousness.
In the physical examination no reduction of strength in the limbs or alterations in the osteotendinous reflexes were detected.
He had a stable, non-pathological gait without dysmetria.
He had progressively recovered his muscle strength a few minutes ago.
A fine distal tremor was discovered without exophthalmos.
The heart rate was 120 beats per minute, presenting nodules as consolidation of a thyroid gland of increased size.
An emergency analytical was performed which detected: creatinine 0.59 mg/dl (normal 0.60-1.35), sodium 142 mEq/L (135-145), potassium 2.07 mEq/l (3.5-5), calcium 142 mEq/dl (135-145), total potassium 2.07 mEq/l (85.3-1050), magnesium
A clinical picture of loss of strength and hypokalemia led us to the diagnosis of periodic paralysis.
Given the presence of a characteristic half-life of thyroid disease, a hormonal study was requested, finding primary hyperthyroidism of autoimmune origin with T4L (T4L) levels: T4L (0.860-2.760 IU), anti-TSHb (0.475) antibodies (0.75 IU/ml) and T4L): 0.008, T4L, T4L) and T4L parameters: 0.008, T4L, T4
Vitamin D and PTH were normal (28 ng/mL [20-5 and 26 pg/mL] [11-80], respectively).
The first complementary test to be requested in the presence of hyperthyroidism is thyroid scintigraphy, which in our case showed diffuse hyperuptake.
All these data led us to Graves' disease as the cause of the condition.
In the acute phase, treatment with 40 mEq of intravenous potassium was started, resulting in a decrease in normalization of the levels (4.1 mEq/L), and progressive propranol 10 mg and methimazole 30 mg daily were administered at home.
Currently, the patient remains on methimazole 5 mg daily with partial remission of symptoms and normal thyroid function, without presenting new episodes of paralysis.
