Three cases of thyrotoxic periodic paralysis due to painless thyroiditis
A 35-year-old male presented with sudden onset quadriparesis with a history identical to that of case 1. He had upper limb proximal muscle powers MRC 3/5, distal muscles 4/5, lower limbs proximal, and distal muscles 2/5. Mild respiratory muscle involvement was evidenced by reduced single breath count of 11 seconds. DTR on all limbs were diminished with bilaterally flexor plantar responses and no cranial nerve palsy. He had a grade 1 goiter and no signs of toxicity. His serum potassium was 1.5 mmol/l, ESR 42 mm/h, TSH 0.005 μU/l, free T4 2.5 ng/dl, TPO antibody 68 IU/ml, and decreased uptake (0.1%) on 99mTc scan.