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.