Unusual case of weakness in the UK

A healthy 35-year-old Vietnamese man presented with acute tetraparesis. He was watching television when suddenly he could not mobilise. As the weakness progressed overnight he attended the accident and emergency department. Observations were normal. He denied any pain, headache, vomiting, diarrhoea...

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Bibliographic Details
Published in:BMJ case reports 2010-10, Vol.2010 (oct18 2), p.bcr0320102785-bcr0320102785
Main Authors: Ngu, W S, Tymms, D J
Format: Article
Language:English
Subjects:
Adult
Antithyroid Agents - therapeutic use
Carbimazole - therapeutic use
Case reports
Diagnosis, Differential
Disease Progression
Drug Therapy, Combination
Emigrants and Immigrants
Graves Disease - diagnosis
Graves Disease - drug therapy
Guillain-Barre syndrome
Humans
Hypokalemia
Hypokalemic Periodic Paralysis - diagnosis
Hypokalemic Periodic Paralysis - drug therapy
Male
Muscle Weakness - drug therapy
Muscle Weakness - etiology
Neurologic Examination
Other Asian
Paralysis
Patients
Potassium
Potassium - therapeutic use
Quadriplegia - drug therapy
Quadriplegia - etiology
Thyroid Crisis - diagnosis
Thyroid Crisis - drug therapy
Thyroid gland
United Kingdom
Unusual Association of Diseases/Symptoms
Vietnam - ethnology
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Summary:A healthy 35-year-old Vietnamese man presented with acute tetraparesis. He was watching television when suddenly he could not mobilise. As the weakness progressed overnight he attended the accident and emergency department. Observations were normal. He denied any pain, headache, vomiting, diarrhoea or use of laxatives or illicit drugs. Neurological examination revealed global weakness in all four limbs ranging from 0 to 3/5. Reflexes were suppressed. Examination of cranial nerves and of other systems was unremarkable. However, laboratory results showed a hypokalaemia of 2.3 (3.5–5.5 mmol/l) on admission. ECG first showed U waves and Mobitz type 1 but this resolved to sinus rhythm. On further questioning, he revealed a recent weight loss of 9 kg despite an increase in appetite. Thyroid function tests revealed free T4 57 (12–22 pmol/l) with thyroid-stimulating hormone undetectable. He was treated with potassium replacement and carbimazole and his symptoms resolved completely 8 days post-admission. The patient was diagnosed with hypokalaemic thyrotoxic periodic paralysis.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.03.2010.2785