Thyrotoxic periodic paralysis: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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==Clinical Features== | ==Clinical Features== | ||
*Painless weakness especially after exercise or diet changes | *Painless [[weakness]] especially after exercise or diet changes | ||
*Lasting hours to days | *Lasting hours to days | ||
*Most common from 20-40 years old | *Most common from 20-40 years old | ||
*Physical Exam | *Physical Exam | ||
**Proximal> | **Proximal > distal muscle weakness | ||
**Hyporeflexia or areflexia | **Hyporeflexia or areflexia | ||
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==Evaluation== | ==Evaluation== | ||
*Hypokalemia | *[[Hypokalemia]] | ||
*[[Thyrotoxicosis]] | *[[Thyrotoxicosis]] | ||
*EMG | *EMG | ||
Latest revision as of 16:57, 28 September 2019
Background
- Periodic paralysis occurs from hypokalemia, hyperkalemia, and hyperthyroidism
- More common in males
- More common in Asians
- A variant of hypokalemic periodic paralysis
Clinical Features
- Painless weakness especially after exercise or diet changes
- Lasting hours to days
- Most common from 20-40 years old
- Physical Exam
- Proximal > distal muscle weakness
- Hyporeflexia or areflexia
Differential Diagnosis
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Evaluation
Management
Disposition
- Telemetry admission
- Endocrine consult