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Thyrotoxic periodic paralysis triggered by β2-adrenergic bronchodilators
CJEM
|May 24, 2014
Summary
Thyrotoxic periodic paralysis (TPP) can be triggered by bronchodilators, leading to muscle paralysis. This study highlights the link between β2-adrenergic bronchodilators and TPP attacks in undiagnosed patients.
Area of Science:
- Endocrinology
- Neurology
- Genetics
Background:
- Hypokalemic periodic paralysis is a common neuromuscular disorder characterized by muscle weakness and low serum potassium.
- Thyrotoxic periodic paralysis (TPP) is a subtype of hypokalemic periodic paralysis, often associated with hyperthyroidism.
Observation:
- Two young men experienced sudden muscle paralysis after receiving inhaled β2-adrenergic bronchodilators for asthma.
- Physical examination revealed enlarged thyroid glands and flaccid paralysis with areflexia in the lower extremities.
- Laboratory tests showed hypokalemia with low urine potassium excretion, indicative of intracellular potassium shift.
Findings:
- Both patients were diagnosed with primary hyperthyroidism due to Graves disease.
- Muscle strength recovered with potassium supplementation, but one patient experienced hyperkalemia.
- These cases represent the first reported instances of TPP triggered by β2-adrenergic bronchodilators.
Implications:
- β2-adrenergic bronchodilators should be recognized as potential precipitants of TPP.
- Early diagnosis and management of hyperthyroidism are crucial in patients presenting with unexplained paralysis.
- This finding necessitates a review of asthma management protocols in patients with undiagnosed thyroid conditions.
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