Acute hypokalemic periodic paralysis after intravenous administration of methylprednisolone in patient with graves’ thyrotoxicosis: A letter to editor

A 42-year-old man as a known case of hyperthyroidism with the first presentations of proptosis and red eye admitted in March 2013 for graves’ thyrotoxicosis ophtalmopathy (Figure 1). In the past year he had 10 kg weight loss without any complaint of appetite decrease. He was a smoker and had a positive family history of goiter in his mother and brother. On the physical examination, the body temperature was normal, with a blood pressure of about 80/110, bilateral eyes conjunctivitis and also increase in the size of the thyroid gland was observed. The patient received intravenous methylprednisolone from the first day of hospitalization. Followed by injection of the second doses on the third day, he mentioned a paresthesia and inability of movement in his lower extremities. Forces of muscles in every four limbs reduced to 2/5 and the potassium level decreased to 2.2. Other laboratory results were as follows: (Ca=7.6, P=1.4, Urea=22, Cr=1, Na=142). Based on these clinical and paraclinic findings, the diagnosis of periodic hypokalemic paralysis confirmed. Prednisolone infusion was stopped immediately and the patient s symptoms completely subsided. Finally, theexperimental results indicate that the potassium level was elevated from 2.2 to 4.6. Now he is in a favorable treatment condition.