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Thyrotoxic hypokalemic periodic paralysis following second-trimester prostaglandin-induced abortion
1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
Background:
Hypokalemic periodic paralysis with thyrotoxicosis has never been described in pregnancy or the puerperium.
Case:
A 31-year-old Hispanic woman underwent three prostaglandin inductions for a second-trimester missed abortion. Her management was complicated by hyperthermia, nausea, vomiting, and diarrhea. She developed isolated proximal muscle paralysis and sensory loss on the first post-abortion day. Her serum potassium was 1.5 mEq/L. The serum free thyroxine index exceeded 25 and TSH was below 0.03 microIU/mL, leading to a diagnosis of thyrotoxic hypokalemic periodic paralysis. Oral and parenteral potassium repletion restored full neurologic function, and propylthiouracil treatment was initiated until thyroid ablation could be performed.
Conclusion:
Gastrointestinal potassium loss during prostaglandin-induced abortion may unmask previously undiagnosed periodic paralysis.