Can’t Move

Author: Susan Allen / Editor: Jason Kendall / Reviewer: Nadarajah Prasanna / Codes: / Published: 20/06/2022

A 27-year-old single Caucasian male attends the emergency department (ED) after an episode of paralysis of his limbs at home.

He woke up at 5am unable to move his arms and legs. However, he could move his head and neck and speak normally. The previous day he had been well. These symptoms improved over the next few hours starting with his arms and then progressing to his legs. He then phoned his mother for help who brought him to the ED, arriving at 1500 hours, by which time he was able to walk again.

He reports that he has had previous episodes of milder transient muscle weakness over the preceding two years and, more recently, some weight loss and a mild tremor of his hands. He is a non-smoker, on no regular medication, and denies recreational drug use. He also reports recent slight weight loss (5kg).

The only abnormal examination findings are a mild postural tremor and mild bilateral lower limb weakness proximally (grade 4/5). There is preserved muscle bulk, normal tendon reflexes and no muscle fatiguability.

You consider a diagnosis of thyrotoxic periodic paralysis (TPP).

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