Hypothyroidsm with Recurrent Hypokalemic Paralysis

Hypokalemic paralysis represents a medical emergency requiring both rapid diagnosis and treatment. The cause of this paralytic disorder may be genetic or acquired. Sudden onset of weakness is triggered by stress such as viral illness, fatigue, fight, emotional disturbance and medications like insulin, beta-2 agonists and steroids. This transient and episodic neurological condition is commonly associated with Thyrotoxicosis. Hypothyroidism presenting as recurrent hypokalemic paralysis is rare in the literature. We report a case of 38 year old female with sudden onset of weakness in lower extremities, no sensory deficits and normal higher mental function. There was no enlargement of thyroid gland. Laboratory evaluation revealed low serum potassium. Patient was diagnosed having chronic thyroiditis with high thyroid stimulating hormone and thyroid related antibodies. Follow up shows satisfactory result with thyroxine replacement. It is an extremely rare and unusual presentation of hypothyroidism with hypokalemic paralysis.