Three cases of thyrotoxic periodic paralysis due to painless thyroiditis
A 21-year-old male presented with sudden onset flaccid quadriparesis with no preceding history of fever, dysphagia, dysphonia, diplopia, bladder, or bowel involvement. There was no relation with heavy carbohydrate meal, exercise or diarrhea, and no past history of similar episode.\nExamination revealed lower limb proximal muscle power of 3/5, diminished deep tendon reflexes (DTR) in all four limbs, bilateral flexor plantar responses, no cranial nerve palsy, and no respiratory muscle involvement. Goiter and clinical feature of thyrotoxicosis were absent. Serum potassium was 2.2 mmol/l (normal [nl.] –3.5-5), and ESR 38 mm/h (nl.–1-25). Thyroid function tests (TFT) showed TSH 0.06 μU/l (nl. –0.5–5), free T4 2.4 ng/dl (nl. 0.7–2.0), T3 210 ng/dl (normal –70–190), and TPO antibody 54 IU/ml (nl. <35). 99mTc pertechnetate thyroid scan uptake was 0.15% (nl.–0.4–1%).