Thyrotoxic Periodic Paralysis Precipitated by Viral Hepatitis

Thyrotoxic hypokalaemic Periodic Paralysis (TPP) is a medical emergency usually seen in Grave’s disease, commonly in persons of oriental descent. The present case is a rare first time presentation of TPP in association with acute viral hepatitis A. A 46-year-old female presented with weakness, vomiting, fever, altered sensorium and yellow discolouration for 20 days. She was diagnosed to have hepatic failure due to viral hepatitis A. The patient’s serum potassium level was 1.79 mmol/L. Treatment for hepatic failure and i.v. potassium chloride replacement was started. Sensorium improved but severe hypokalaemia and flaccid paralysis persisted. Thyroid functions were assessed and thyrotoxicosis due to Grave’s disease was diagnosed. Carbimazole and systemic corticosteroids were also started and potassium infusion was continued. Serum potassium became normal only after thyroid hormones reached normal limits followed by improvement in muscle weakness. TPP can be precipitated in conditions of stress, thyroid functions should be assessed in cases of hypokalaemic periodic paralysis even in absence of overt thyroid disease.