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All Journal Acta Neurologica Indonesia
Hanifa, Jeany
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Medicine & Pharmacology Neuroscience Public Health

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Thyrotoxic Periodic Paralysis Associated With Graves' Disease Pinzon, Rizaldy Taslim; Hanifa, Jeany; Putra, Stefanus Erdana
Acta Neurologica Indonesia Vol. 4 No. 3 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v4i3.145

Abstract

Introduction: Thyrotoxic periodic paralysis is an uncommon, life-threatening complication of hyperthyroidism characterized by acute flaccid paralysis and severe hypokalemia due to an intracellular shift of potassium. Case Report: A 20-year-old male of Southeast Asian descent presented with sudden-onset, symmetrical flaccid quadriparesis upon waking. Neurological examination revealed proximal-predominant muscle weakness and diminished deep tendon reflexes with preserved sensory function. Biochemical evaluation confirmed severe hypokalemia (2.13 mmol/L) accompanied by primary hyperthyroidism, with a suppressed thyroid-stimulating hormone level (<0.05 µIU/L) and elevated free thyroxine (66.7 pmol/L). Electrocardiography demonstrated ST-segment depression and QT-interval prolongation, and thyroid ultrasonography suggested diffuse edema consistent with Graves' disease. Discussion: Cautious intravenous and oral potassium replacement, coupled with oral propranolol and propylthiouracil, led to rapid normalization of potassium levels and complete motor recovery within 24 hours without rebound hyperkalemia. Conclusion: This case emphasizes the necessity of screening for underlying thyroid dysfunction in young adults presenting with unexplained hypokalemia paralysis to prevent fatal cardiopulmonary complications.
Co-Authors Rizaldy Pinzon Stefanus Erdana Putra