Sub Clinical Disease Presenting with Serious Clinical Manifestations - Blame Thyroid.

ABSTRACT

Graves' disease is responsible for 60 to 80% cases of thyrotoxicosis and characteristically presents between the ages of 20 and 50 years.Both environmental and genetic factors lead to the development of Grave’s Disease.(1) Hyperthyroidism seen in grave’s disease is caused by thyroid-stimulating immunoglobulins (TSI) that are synthesized in the thyroid gland, bone marrow and lymph nodes, and detected by direct bioassays or TSH-binding inhibiting immunoglobulin (TBII) assays. Thyroid peroxidase (TPO) antibodies are found in about 80% of cases suggestive of Grave’s Disease.(1) Grave Disease is known to have multiple serious complications like Hypokalemia, Thrombocytopenia, heart rhythm abnormalities, brittle bone and thyroid storm(1,2). Hypokalemia in Grave’s Disease is a rare life-threatening complication seen, mostly in young males, often presents acute onset paraparesis. Paralytic symptoms usually occur after heavy exercise or carbohydrates rich meal.(3)This case report highlights about a young man who presented with quadriparesis, later on investigation diagnosed as hypokalemia due to subclinical grave’s disease.Clinically silent Grave’s Disease presenting with neurological quadriparesis is diagnostic challenge. Neurological paresis rapidly resolves with correction of hypokalemia. This report discusses the case of young man who presented with acute onset quadriparesis without any clue, came out as hypokalemic due to subclinical grave’s disease.