ABSTRACT
Primary hypothyroidism is a common endocrine condition that is encountered. Graves disease and Hashimoto抯 thyroiditis are the most common autoimmune conditions in which conversion of hyperthyroidism to hypothyroidism is seen. Chances of conversion of hypothyroidism to hyperthyroidism is extremely rare. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism. The etiology being an autoimmune switch by an external stimulus in genetically susceptible individuals. Hereby, presenting a case of 53-years female, who is a known case of type II diabetes mellitus, chronic kidney disease, nephrotic syndrome diagnosed with minimal change disease who presented with a hormonal profile showing hyperthyroidism. She had a history of hypothyroidism in the past for 12-years and was treated with levothyroxine and was off treatment for the past 2 years. Further evaluation showed presence of primary Sjogren抯 syndrome which has let to this conversion.
ABSTRACT
Respiratory paralysis due to hypokalemia is a rare entity in Sjogren抯syndrome. Apart from distal renal tubular acidosis (RTA) and hypokalemia the clinical symptoms like dryness of eye, mouth and parotid swelling were absent in our case. Due to this rarity in this pattern of presenting the symptoms, the differential diagnosis of autoimmune disease is often missed and it will eventually end up in a fatal condition. Hypokalemia causes muscle weakness gradually and there will be sudden onset of respiratory paralysis which could be dangerous to the individual. Although there is the presence of rare combination of symptoms clinical history, blood gas analysis, urine analysis and ANA profile will help in the appropriate diagnosis. Herewe report a rare case of male Sjogren抯 syndrome presenting with respiratory paralysis due to hypokalemia.