COVID-19 Infection-Related Thyrotoxic Hypokalemic Periodic Paralysis

Area of Science:

• Endocrinology
• Infectious Diseases
• Internal Medicine

Background:

• Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is known to affect multiple organs, including the thyroid gland.
• Potential mechanisms involve the angiotensin-converting enzyme 2 (ACE2) receptor and the systemic inflammatory response (cytokine storm).
• Thyroid dysfunctions like subacute thyroiditis, Graves' disease, thyrotoxicosis, and Hashimoto's thyroiditis have been reported in COVID-19 patients.

Observation:

• A case study of a male patient admitted with recurrent lower limb weakness following a SARS-CoV-2 diagnosis.
• The patient presented with refractory hypokalemia, persisting despite two months of potassium replacement therapy.
• Initial investigations revealed hyperthyroidism in a patient with no prior thyroid history.

Findings:

• Treatment with oral thiamazole for hyperthyroidism led to the normalization of thyroid hormone levels.
• Concurrently, the patient's potassium levels returned to normal.
• The resolution of hyperthyroidism resulted in the cessation of lower limb weakness.

Implications:

• This case highlights an unusual thyroid complication associated with SARS-CoV-2 infection.
• Hyperthyroidism-induced hypokalemia should be considered in SARS-CoV-2 patients presenting with limb weakness.
• Early diagnosis and appropriate management of these thyroid complications can improve patient outcomes and reduce disease burden.