Hypokalemic Hypophosphatemic Thyrotoxic Periodic Paralysis Associated with Bipolar Disorder Therapy.

Hypokalemic thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism. TPP occurs due to the intracellular shift of potassium in the setting of elevated thyroid hormone. As potassium begins to be replenished, there is a risk of inducing hyperkalemia due to the extracellular shift of potassium. Therefore, it is recommended to replete potassium conservatively. There have been a number of studies reviewing the possible benefits of elevated thyroid hormone in treating bipolar disorder. In this case report, a 37-year-old man with a past medical history of hypothyroidism and bipolar disorder presented with bilateral lower extremity paralysis. Liothyronine was added to his stable hypothyroid regimen for bipolar management. His initial labs on presentation were notable for severe hypokalemia, hypophosphatemia, and an undetectable thyroid-stimulating hormone (TSH). He was diagnosed with TPP, and his electrolytes were corrected with minimal repletion within 24 hours. More research is still required before concluding the role of thyroid hormone in mood disorders. This case report demonstrates a serious complication of supplemental thyroid hormone use. It is crucial to monitor thyroid function tests closely in order to avoid iatrogenic hyperthyroidism.

Debulking of Advanced Gastrointestinal Stromal Tumor With Peritoneal Carcinomatosis Refractory to Imatinib and Sunitinib: A Case Report.

Gastrointestinal stromal tumors (GISTs) are non-epithelial stromal tumors that arise in the gastrointestinal tract. Pharmacological treatments for GIST are tyrosine kinase inhibitors. For metastatic disease, debulking may be helpful in reducing the tumor burden, thus increasing the effectiveness of tyrosine kinase inhibitors. Debate on whether resection would benefit the patient is still present. Here is a case of a 52-year-old African American male presenting with metastatic malignant GIST with peritoneal carcinomatosis refractory to imatinib and sunitinib. Since this patient had stage IV metastasis it was ultimately decided to proceed with a therapeutic debulking procedure. For this patient, the procedure increased the effectiveness of the medication and reduced mass effect symptoms, improving quality of life.