Open AccessThyrotoxic Periodic Paralysis: A Spine Consultation
Author(s) -
Samuel J. Mease,
Michael Faloon,
Conor Dunn,
Stuart Changoor,
Nikhil Sahai,
Awais K. Hussain,
Arash Emami
Publication year - 2019
Publication title -
journal of the american academy of orthopaedic surgeons. global research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.358
H-Index - 2
ISSN - 2474-7661
DOI - 10.5435/jaaosglobal-d-18-00082
Subject(s) - medicine , weakness , paralysis , thyrotoxic periodic paralysis , medical diagnosis , presentation (obstetrics) , differential diagnosis , periodic paralysis , physical therapy , surgery , pediatrics , radiology , pathology
As a consultant, the orthopaedic spine surgeon is often asked to evaluate patients with acute-onset extremity weakness. In some cases, patient's deficits can be attributed to nonspinal pathology; therefore, it is important to be aware of nonorthopaedic diagnoses when evaluating these patients. We report a case of thyrotoxic periodic paralysis that was initially confused by the consulting service with spinal pathology. A 32-year-old Hispanic man presented to our emergency department with rapid onset of lower extremity weakness. The consulting team ordered CT of the cervical and lumbar spine, as well as MRI of the lumbar spine which was aborted due to the patient's worsening tachycardia and chest pain. The spine service was subsequently consulted to evaluate the patient. Review of the metabolic panel revealed a low potassium, and additional testing led to the eventual diagnosis of thyrotoxic periodic paralysis. After correction of the patient's potassium, his weakness rapidly resolved, and no additional spinal workup was pursued. We describe this patient's presentation and outline the differential diagnosis for acute, nontraumatic extremity weakness, including both orthopaedic and other medical causes, that the spine surgeon should be aware of when evaluating patients with extremity weakness.