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Z A Sayiner, A Abiyev, A Eraydin, M Ozkaya, A rare cause of thyrotoxic periodic paralysis: liquorice consumption, Postgraduate Medical Journal, Volume 93, Issue 1099, May 2017, Pages 295–296, https://doi.org/10.1136/postgradmedj-2016-134716
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Introduction
Thyrotoxic periodic paralysis (TPP) is the most common form of acquired hypokalaemic periodic paralysis. The most common precipitating factors of the disease are a high-carbohydrate diet and exercise.1 2 Some TPP cases with normal potassium levels have also been reported, but diagnosis is difficult and rare.3 The duration of the attacks is typically a few hours. Severity of attacks correlates with serum potassium level.4 It is known that the chronic use of liquorice causes symptoms similar to the mineralocorticoid secretion (apparent mineralocorticoid excess) syndrome, leading to findings such as hypertension, hypokalaemia, metabolic alkalosis.5 So far about 40 cases of hypokalaemic paralysis due to liquorice use have been reported in the literature. However, only one case of liquorice-induced TPP has previously been reported. We describe another case who presented with hypokalaemia, hyperthyroid state and paralysis after the habitual consumption of liquorice.
Case report
A 43-year-old male patient was admitted to the emergency department and was unable to walk and had weakness in the upper and lower extremities that had started 4 hours previously. The patient’s story reveals that his complaints began suddenly. At the same time, it was learned that the patient had been diagnosed with Graves’ disease 2 months previously. The patient was prescribed methimazole 20 mg/day and propranolol 40 mg/day as pretreatment before initiation of permanent treatment, until euthyroid was provided and the patient was using the drugs irregularly. Apart from that, the patient had no known history of chronic or neurological disease.
