Silent Paralysis: Recurrent Thyrotoxic Periodic Paralysis in a Young Hispanic Male With Graves' Disease

Thyrotoxic periodic paralysis is a rare, life-threatening complication of thyrotoxicosis, characterized by hypokalemia, hyperthyroidism, and acute muscle weakness. It often occurs in Graves' disease but is not directly linked to the severity or duration of thyrotoxicosis. The objective of this report is to describe a patient with Graves' disease and thyrotoxic periodic paralysis, emphasizing the importance of achieving an euthyroid state, potassium repletion, and the role of β-blockers in management.

A 23-year-old male with a history of untreated hyperthyroidism presented to the emergency department with palpitations and worsening bilateral lower extremity weakness, culminating in an inability to walk.The patient reported previous episodes of weakness associated with his hyperthyroidism. Physical examination revealed marked muscle weakness and hypertension. Following evaluation, the patient was diagnosed with Graves' disease. He was treated with potassium, magnesium, methimazole, and propranolol, resulting in rapid improvement of his symptoms, and was discharged with outpatient follow-up.

Thyrotoxic periodic paralysis is a rare manifestation of thyrotoxicosis, which can be precipitated by stressors or medication noncompliance. The pathophysiology involves thyroid hormone-induced shifts in potassium, leading to hypokalemia and muscle weakness. Treatment consists of normalizing thyroid function, managing potassium, and using β-blockers to counteract the overstimulation of muscle cells by thyroid hormones and catecholamines. However, the precise role of β-blockers in preventing attacks requires further investigation.

Early diagnosis and treatment of thyrotoxic periodic paralysis, including euthyroid restoration and potassium management, are critical. While β-blockers may be effective in symptom resolution, further studies are needed to clarify their role in preventing attacks.