A rare case of thyrotoxic periodic paralysis in a black male

Background: Thyrotoxic periodic paralysis (TPP) is a disorder characterized by episodes of muscle weakness to paralysis. Hypokalemia precipitated by high levels of circulating thyroid hormone is almost always associated with it. Although commonly seen in Asian men it is also reported in Polynesians, Caucasians and very rarely in African Americans. Here we present an African American patient with Graves' disease and TPP. Case Report: A 29 yr old black male with no significant past medical history presented to the emergency room with inability to move lower extremities. He gave history of similar episodes of transient paralysis in the recent past. After initial stabilization in the emergency room he followed in the outpatient clinic for further workup. His physical exam was unremarkable except for non tender firm enlarged thyroid gland. Thyroid function tests showed a low TSH, high T3 and, an elevated Microsomal antibody titer of 6400. A thyroid uptake scan revealed enlarged thyroid gland with uniform uptake consistent with Graves' disease. After thyroid ablation he remained symptom free. Conclusions: TPP is a condition characterized by transient paralysis seen in hyperthyroid patients. Though mostly seen in males of Asian descent this potentially curable condition should be considered in the differential of any patient with transient periodic paralysis.