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Case Reports
. 2022 Feb 22:75:103389.
doi: 10.1016/j.amsu.2022.103389. eCollection 2022 Mar.

Hypokalemic periodic paralysis and renal tubular acidosis in a patient with hypothyroid and autoimmune disease

Cynthia Ayu Permatasari  1 , Harida Zahraini  1 , Ferdy Royland Marpaung  2 , Aryati  2
Affiliations
Case Reports

Hypokalemic periodic paralysis and renal tubular acidosis in a patient with hypothyroid and autoimmune disease

Cynthia Ayu Permatasari et al. Ann Med Surg (Lond). .

Abstract

Background: Hypokalemic periodic paralysis (HPP) is a rare muscle disorder characterized by episodic muscle weakness that can lead to respiratory failure. This disorder is a common manifestation of renal tubular acidosis. Renal tubular acidosis can occur associated with various systemic disorders such as Sjogren's syndrome and thyroid disorders.

Case presentation: A 58-year-old woman complained of weakness in all extremities. In the last 3 years, the patient was diagnosed with hypothyroidism and got recurrent hypokalemia without vomiting or diarrhea. The examination showed blood pressure of 110/70 mmHg, pulse rate of 98 ×/m, temperature of 36.8 °C, and respiratory rate of 20 ×/m. Motor strength 2 in all four extremities. The ECG examination showed 1st degree AV block. Laboratory examination found hypokalemia, metabolic acidosis with a normal anion gap of 13.8 meq/L, urine pH 8.0, urine anion gap 41 mmol/h. FT4 1.89 ng/dL, TSH 1.21 IU/mL. Anti TPO 20.6 IU/mL, ANA profile: strong positive SS-A (Ro), Ro-52, SS-B (La) which indicates Sjogren's syndrome.

Discussion: HPP is a rare case so the accuracy of diagnosis increases the success of treatment.

Conclusion: The patient was diagnosed with HPP and renal tubular acidosis based on hypokalemia, metabolic acidosis, alkaline urine, and positive urine anion gap.

Keywords: Autoimmune; HPP; Hypothyroid; Renal tubular acidosis; Sjogren's syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

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ECG results.
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