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Case Reports in Endocrinology
Volume 2018, Article ID 9763452, 3 pages
Case Report

Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department

Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150, Western Australia, Australia

Correspondence should be addressed to Nick Si Rui Lan;

Received 6 April 2018; Accepted 13 May 2018; Published 7 June 2018

Academic Editor: Wayne V. Moore

Copyright © 2018 Nick Si Rui Lan and P. Gerry Fegan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient’s symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves’ disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves’ disease and should be considered in the differential diagnosis in patients presenting with weakness.