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Biochemical Reconstitution of Steroid Receptor•Hsp90 Protein Complexes and Reactivation of Ligand Binding
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Steroids and Thyrotoxicosis Precipitate Periodic Paralysis
Rizwan Ahamed1, Sarah McCalley1, Anupam A Sule1
1Internal Medicine, St. Joseph Mercy Oakland Hospital.
Cureus
|March 28, 2018
Summary
Thyrotoxic Periodic Paralysis (TPP) is a rare channelopathy causing muscle weakness. Steroids like dexamethasone can trigger TPP attacks in hyperthyroid patients, necessitating clinical awareness.
Area of Science:
- Endocrinology
- Neurology
- Genetics
Background:
- Thyrotoxic Periodic Paralysis (TPP) is an episodic neuromuscular disorder characterized by painless muscle weakness.
- It is a channelopathy, often linked to hyperthyroidism and electrolyte imbalances, particularly hypokalemia.
Observation:
- A 29-year-old male with hyperthyroidism presented with severe leg weakness after receiving dexamethasone for uvulitis.
- He had a similar episode previously following a steroid injection, with laboratory findings revealing hypokalemia and suppressed TSH with elevated free T3/T4.
Findings:
- The patient's symptoms resolved with aggressive electrolyte replacement and resumption of his anti-thyroid medications.
- This case highlights that glucocorticoids, while used for thyroid storm, can precipitate TPP in susceptible hyperthyroid individuals.
Implications:
- Clinicians must consider TPP as a potential complication when prescribing steroids to male patients with hyperthyroidism.
- Awareness of this rare but significant adverse effect of glucocorticoids is crucial for patient safety and effective management.
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