Graves’ Disease and Periodic Paralysis

Abstract

Thyrotoxic periodic paralysis represents a rare neurological emergency of an endocrine disorder. It poses a diagnostic challenge to the clinicians, as it is an uncommon disorder and its clinical presentation is similar to the more common hypokalemic paralysis. Adding to the diagnostic dilemma is that most patients do not have prior history of thyroid disorder and only have subtle features of hyperthyroidism. Hence, the diagnosis can be easily missed without a high clinical index of suspicion. These patients usually present to the emergency department with acute flaccid paralysis and all physicians should be aware of this clinical entity. The disease can be life-threatening if early diagnosis and prompt therapy is not initiated. We report three interesting cases in which periodic paralysis was the initial manifestation of underlying Graves’ disease in two and occurred in the third case who was previously diagnosed with thyrotoxicosis  due to non-adherence to drug therapy.