Abstract
Hypokalemia can be multifactorial. When the primary driver of
hypokalemia is obvious it is easy to miss other contributing causes that
could be vital to optimal patient management and outcomes. Our case
report highlights the importance of recognizing recurrent, refractory
hypokalemia as a diagnostic clue to thyrotoxic periodic paralysis.
Key words: refractory hypokalemia, diagnostic clue, thyrotoxic
periodic paralysis, T3 toxicosis, Guillain-Barre syndrome,
rhabdomyolysis, acute kidney injury
Introduction: Most cases of thyrotoxic periodic paralysis have
been reported in Asian men with the incidence of about 2% in thyrotoxic
patients [1]. However, the incidence is reported to be only 0.1 to
0.2% in non-Asian population [2]. A very high degree of clinical
suspicion is therefore needed to diagnose thyrotoxic periodic paralysis
in non-Asian population. We present a case of thyrotoxic periodic
paralysis in a 34y old Caucasian male who presented with clinical
features suspicious of Guillain-Barre (GB) syndrome where the finding of
severe, recurrent and refractory hypokalemia served as a key diagnostic
clue for timely diagnoses and management of thyrotoxic periodic
paralysis.