Hospital course:
Because of initial suspicion of Guillian-Barre (GB) syndrome patient was
started on intravenous immunoglobulin (IVIG). After 180 mEq of potassium
replacement, potassium level was 1.8mEq/L (Table-2). Because of
recurrent, refractory hypokalemia in the absence of other identifiable
triggers (discussed below), thyrotoxic periodic paralysis was suspected
and T3 toxicosis was found in the thyroid lab panel. Patient had
significant improvement in muscle weakness and potassium levels after
treatment with methimazole and propranolol in addition to ongoing
potassium replacements (Table 2). Tenofovir was stopped. Patient was
discharged on Methimazole 20mg twice daily and Propranolol 40mg every 6
hours.