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Título

Hyperthyroidism presenting with hypokalemic periodic paralysis and cluster headache: a case report

RESUMO

Case Report: A 26-year-old Brazilian male, without known comorbidities, presented with acute flaccid tetraparesis. He reported an abusive carbohydrate intake the previous night. He denied strenuous physical exercise, fever, recent trauma, loss of sphincter control, use of medications, drugs or alcohol. On neurological examination, he presented flaccid tetraparesis with proximal weakness predominance. Laboratory investigation showed serum potassium 2.89 mEq/L and there was no alteration on neuroimaging. After treatment with intravenous potassium, the patient completely recovered his motor strength in four hours. During outpatient follow-up, he reported episodes of headache described as a left-sided excruciating pain, originated in the orbital region, irradiated to supraorbital and temporal region, lasting 15 minutes. The pain was associated with ipsilateral ptosis. Results of analysis collected during hospitalization showed TSH (<0.01μUI/mL), T4 (6.11 ng/dL), TRAB (4.7 UI/L). The patient was diagnosed with Thyrotoxic Hypokalemic Periodic Paralysis (TPP) and met the criteria for cluster headache. He was treated with tiamazol and atenolol for hyperthyroidism. He started prophylactic and symptomatic treatment for cluster headache. Five months after hospital discharge, the patient denied new episodes of acute tetraparesis and episodes of cluster headache.
Discussion: TPP is a very rare complication of thyrotoxicosis, more frequent in the Asian population. It must be considered as a differential diagnosis of acute tetraparesis. The role of thyroid dysfunction in the etiology of headache remains uncertain. In literature, there are cases of patients with newly diagnosed hyperthyroidism whose headaches remitted after treatment of hyperthyroidism. A study found reduced TSH response to thyrotropin-releasing hormone (TRH) in patients with cluster headache during cluster period, hypothesizing a hypothalamic involvement in the pathogenesis.
Final comments: We report this case to emphasize the importance of the evaluation of thyroid function in patients with acute flaccid tetraparesis. Timely recognition and treatment of TPP can reduce the risk of severe complications such as respiratory muscle weakness and arrhythmias. Further studies are needed to clarify the association between hyperthyroidism and cluster headache, but physicians should be aware that there may be a correlation and consider a thyroid function assessment.

Palavras Chave

hyperthyroidism, hypokalemic periodic paralysis, cluster headache

Área

Doenças Neuromusculares