THYROTOXICOSIS AND RENAL TUBULAR-ACIDOSIS PRESENTING AS HYPOKALEMIC PARALYSIS

A 34-yr-old Chinese woman presented with hypokalaemic periodic paralys is. She had a goitre and was biochemically thyrotoxic. However, she al so had urinary potassium loss with a metabolic acidosis and reduced ab ility to acidify her urine. The co-existence of distal renal tubular a cidosis (RTA) was confirmed. There was no evidence of xerostomia or xe rophthalmia, although anti-Iio antibody and rheumatoid factor were pos itive. Paralytic attacks did not recur after the thyrotoxicosis was co ntrolled with radioactive iodine. Possible pathogenic mechanisms for t he association of these disorders are discussed. Female patients prese nting with thyrotoxic periodic paralysis (TPP) should be thoroughly in vestigated for possible additional precipitating factors in view of th e strong male predominance of TPP, particularly when there are atypica l metabolic features.