All flaccid paralysis is not GBS, some are ??? A case report and systematic review

Background: Among the ion channel diseases, there is a rare group of neuromuscular disorders known as periodic paralysis, which is associated with mutations in the skeletal muscle sodium, calcium, and potassium channels. The attacks are precipitated by exercise or diet and often have alterations in serum potassium levels. Thyrotoxic hypokalemic periodic paralysis is an uncommon acquired neuroendocrine condition that presents with the triad of hypokalemia, thyrotoxicosis, and sudden onset of muscle weakness especially occurring at night. Case Presentation: A 30-year-old male presented to the hospital with the chief complaint of acute onset weakness of all four limbs (lower limbs more than the upper limb) for the past 1 day. Deep tendon reflexes were diminished in both upper limbs and absent in both lower limbs, and the plantar response was mute bilaterally. In the initial laboratory investigation, the thyroid stimulating hormone (TSH) level was 0.025 μIU/mL and the potassium level was 2.20 mmol/L. An intravenous infusion of potassium chloride was initiated along with tablet propranolol and tablet carbimazole. The patient recovered successfully. Conclusion: Early recognition and prompt treatment are critical to prevent complications and ensure rapid recovery in thyrotoxic periodic paralysis.