27-year-old construction worker has attacks of paralysis. Doctors find rare condition
Five months after moving to Boston from El Salvador, a 27-year-old man started feeling weakness and pain in his legs, and soon he couldn’t move them at all.
In addition to the pain and weakness, he started to have trouble falling asleep and staying asleep, and despite having a normal appetite he began to lose weight, according to a case report published April 24 in the New England Journal of Medicine.
The man spent his days as a construction worker, and having just moved to the country, he attributed his symptoms to stress and powered through the pain and exhaustion. Then, he woke up one morning and his legs were paralyzed, according to the report.
The Case
He asked his family to take him to the emergency room where he told doctors his symptoms had been getting worse the past three days, until he couldn’t stand.
He told doctors he hadn’t been injured on the job, but had noticed a tremor in his hands the past few months, which he associated with stress, according to the case report.
He didn’t smoke or do drugs and only drank alcohol occasionally.
An aunt had experienced a similar feeling of weakness before, but he told doctors he didn’t know if she had ever received a diagnosis, the authors said. His medical team started to run some tests.
The 27-year-old’s oxygen intake was normal, he could still feel a light touch and changes in temperature on his legs, and a blood count showed his blood was clotting as expected, according to the case report.
The doctors noticed a “fine tremor,” as well as particularly high creatine kinase levels, an enzyme that leaks into the bloodstream when muscles or tissue sustain damage like an injury.
Then the doctors found something alarming. The man had a potassium level of 1.8, when a normal range is 3.4 to 5, according to the case report.
In hopes of increasing his potassium, he was given potassium chloride orally, the doctors said. Three hours later, he had regained strength in his arms and legs and his potassium levels were back in a safe range.
The Diagnosis
Potassium is one of the most abundant minerals in the body, 80% of which is found in muscle cells, according to Healthline.
When the body doesn’t have enough potassium it results in a condition called hypokalemia. When the levels are low enough, it can impact the muscles ability to function properly, causing a rare condition called thyrotoxic periodic paralysis, or TPP.
TPP causes “acute proximal symmetrical lower limb weakness,” or sudden attacks of paralysis in your legs, according to the National Institutes of Health. If left to progress, the paralysis can spread to other extremities and the respiratory system, meaning you can stop breathing if your potassium levels get too low, a life-threatening condition.
For the 27-year-old construction worker, the problem was an undiagnosed autoimmune condition that impacts the thyroid, called Graves’ disease.
Doctors took an ultrasound of the man’s thyroid gland which showed an increased blood flow to the area, findings “compatible with a clinical diagnosis of Graves’ disease,” according to the case report.
Graves’ disease is likely caused by genetics, according to the Mayo Clinic, meaning a family history may have been present for the man’s aunt, though a diagnosis was not known.
It is relatively rare, impacting only 1.2% of Americans, despite accounting for between 60% and 80% of all overactive thyroid cases, according to the Cleveland Clinic.
It can cause tremors in the hands, weight loss, difficulty sleeping, enlargement of the thyroid, and in the man’s case, decreased potassium levels, according to Mayo Clinic.
The Treatment
The 27-year-old in Boston was given a few management options, but since the condition was life-threatening and would impact his ability to live a normal life, he chose a total thyroidectomy, according to the study. The procedure completely removes the thyroid and then the patient relies on medications to imitate the thyroid’s function.
When the man’s thyroid was examined after removal, a pathologist confirmed the diagnosis of Graves’ disease, according to the case report.
After the surgery, the man started levothyroxine replacement, to supplement the hormones regulated by his thyroid, and was able to go back to his daily activities without fear of paralysis, the doctors said. His chemical levels stayed normal in a follow-up appointment.
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