Acute Flaccid Tetraparesis after COVID-19 Infection: Think of the Thyroid.

Abstract

A previously well 32-year-old Chinese male presented with acute bilateral upper and lower limb paralysis upon waking, ten days after the onset of COVID-19 infection. Examination revealed areflexia over all four limbs, associated with reduced muscle strength, but no sensory or cranial nerve deficit. Initial concern was Guillain-Barre syndrome given the acute flaccid paralysis following COVID-19 infection. However, investigations revealed severe hypokalaemia (1.7 mmol/L) and primary hyperthyroidism. He was treated for thyrotoxic periodic paralysis (TPP) with β-blockers, antithyroid medications, and intravenous potassium chloride (KCl). Despite frequent monitoring of potassium, rebound hyperkalaemia occurred with prompt resolution of paralysis.

• Authors: Sarah Ying Tse Tan, Jiaqing Xiong, Troy H Puar, Joan Khoo, Andy Jun-Wei Wong, Shui Boon Soh
• Journal: Case reports in medicine (Case Rep Med) Vol. 2022 Pg. 5827664 ( 2022) ISSN: 1687-9627 [Print] United States
• PMID: 35531575 (Publication Type: Case Reports)
• Copyright: Copyright © 2022 Sarah Ying Tse Tan et al.