Thyrotoxic periodic paralysis induced by pulse methylprednisolone

Area of Science:

• Neurology
• Endocrinology
• Internal Medicine

Background:

• Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder.
• Corticosteroids like methylprednisolone are used to manage CIDP.
• Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, often presenting with hypokalemia and paralysis.

Observation:

• A young Thai male with CIDP developed acute flaccid paralysis following pulse methylprednisolone therapy.
• Laboratory findings revealed hypokalemia, confirmed by transtubular potassium gradient (TTKG).
• The patient's condition improved with potassium supplementation.

Findings:

• The patient was diagnosed with Graves' disease, a common cause of hyperthyroidism.
• Steroid administration potentially unmasked or exacerbated underlying thyrotoxicosis, leading to TPP.
• This case highlights a potential drug-induced complication of steroid therapy in susceptible individuals.

Implications:

• Acute paralysis after steroid use should prompt consideration of thyrotoxic periodic paralysis (TPP).
• Early diagnosis and management of TPP, including potassium replacement and treatment of hyperthyroidism, are crucial.
• Understanding the interplay between steroids, thyroid status, and potassium regulation is important for clinical practice.