Hypokalemic Periodic Paralysis and Renal Tubular Acidosis in Patient withHypothyroidism
Keywords:Hypokalemia Periodic Paralisis, Renal Tubular Acidosis, Hypothyroidism.
Hypokalemiaperiodic paralysis (HPP) is a rare disorder characterized by acute muscle paralysis. Based
on its etiology, HPP can be classified as primary and secondary types. One of the most common causes of
secondary HPP is renal tubular acidosis (RTA) which may be also present in thyroid disease. We observed a
case of a 48-year-old female, with complaints of weakness in both lower extremities for two days. Difficulties
in walking and weakness in both arms were also present. Patient also experienced nausea, vomiting, and
diarrhea 4 days before coming to the hospital. She had a history of thyroidectomy in 2009 and in 2019 was
admitted for similar symptoms. Medication consumed by the patient were Euthyrox 100 mg one time daily
and KSR 600 mg three times daily. In the last week, Euthyrox was discontinued by the patient due to her
diarrhea. The patient’s general condition was weak and vital signs were BP 120/80 mmHg, pulse 84 bpm, RR
18 times per minute and temperature was 36.6°C. Motoric strength was 4/4 in both arms and 3/3 in both legs.
No pathological neurological reflexes were found during examination. Inverted T wave and prominent U
wave were seen on electrocardiogram (ECG) results.Laboratory results showed hypokalemia (2.0 mmol/L),
Blood Gas Analysis: Metabolic Acidosis (pH 7.42, pCO2 32 mmHg, HCO3 20.8 mmol/L, BE -3.7 mmol/L)
with anion gap of 14.2 meq/L. Urinalysis results were pH 8, urinary anion gap 18.29 mmol/h. Decreased
thyroid function was also shown in the endocrine laboratory panel FT4 0.57 ng/dl and TSH 32.097 IU/
mL.HPP is a disorder characterized by muscle weakness and may be present in distal type RTA. Clinical
symptoms of distal type RTA are hypokalemia, hyperchloremic metabolic acidosis, urinary pH <5.5. Distal
type RTA can be caused by endocrine disorder i.e., hypothyroidism. Observation of patient condition and
laboratory results lead to the conclusion that the patient is diagnosed with hypokalemic periodic paralysis
and renal tubular acidosis based on hypokalemia, metabolic acidosis with normal anion gap, and alkaline
urine with positive urinary anion gap.
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