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Cited by 13Thyroid Disorders and TreatmentsPotassium and Related DisordersMedical Case Reports and Studies

A rare case of thyrotoxic periodic paralysis after epidural steroid injection: a case report and literature review

Open access
Affram, Kwame Ofori, Reddy, Tanya Luke, Osei, Kofi M.·2018·American Journal of Case Reports
DOI 10.12659/ajcr.911270PMC PMC6293861
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Abstract

BACKGROUND Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases. CASE REPORT A 36-year-old Asian man presented to the emergency department with sudden onset of paralysis of all his limbs following epidural steroid injection for traumatic low back pain. At presentation, he was found to have severe hypokalemia of 1.8 mEq/L. Further investigations led to the diagnosis of hyperthyroidism and Graves' disease. In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected. He had a rapid recovery and an early discharge from hospital. CONCLUSIONS Although several factors can lead to paralysis after an epidural steroid injection, TPP should be considered in the differential diagnosis, especially in individuals who have predisposing factors of ethnicity and gender. If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed. In the management of patients with TPP, care should be taken when correcting potassium levels.

AI snapshot

Written from the paper’s full text.

TL;DR

A 36-year-old Asian man developed acute flaccid paralysis with severe hypokalemia (1.8 mEq/L) four hours after epidural steroid injection and was diagnosed with thyrotoxic periodic paralysis due to Graves’ disease. The case highlights epidural steroid injection as a rare TPP trigger and the need to anticipate rebound hyperkalemia during potassium correction.

Key findings

  • Four hours after epidural steroid injection, the patient had sudden limb weakness/paralysis, with power 1/5 in both lower limbs and 4/5 in upper limbs; initial potassium was 1.8 mEq/L, and urine potassium/creatinine ratio was 7.61 mEq/g (0.81 mEq/mmol), suggesting transcellular shift rather than renal loss.
  • Laboratory findings included TSH 0.100 mciu/ml one month prior, random blood glucose 176 mg/dl, HbA1c 5.1%, and elevated thyroglobulin, thyroid peroxidase, and anti-TSH receptor antibodies; ultrasonography confirmed diffusely enlarged thyroid, leading to a diagnosis of Graves’ disease and TPP.
  • Potassium correction with 100 mEq IV potassium chloride overcorrected serum potassium from 1.8 mEq/L to 6.3 mEq/L; hyperkalemia was treated with calcium gluconate and insulin, and paralysis improved within three hours, with assisted ambulation within six hours and baseline potassium within nine hours.
  • The literature review found no previously published case of TPP after epidural steroid injection; one prior case of hypokalemic paralysis after epidural steroid injection was not associated with thyrotoxicosis.

Methods

  • Single case report with a literature review of steroid-triggered TPP and paralysis after epidural steroid injection.
  • Data included clinical examination, serum and urine laboratory tests, ECG, lumbar spine MRI, thyroid function/antibodies, and thyroid ultrasonography from a 36-year-old Asian man.
  • Main analysis was descriptive synthesis of the case and prior reported cases; no statistical analysis was reported.

Limitations

  • Stated in the paper: the authors could not acquire external records detailing the nature and dose of the steroid used for the epidural injection.
  • Evident from the text: as a single case report, it cannot establish causality or generalizability.
  • Evident from the text: the literature review is narrative, with no described systematic search strategy or inclusion criteria.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.12659/ajcr.911270

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    To the authors' knowledge, this is the first case report of TPP following epidural steroid injection.

    “To our knowledge, this is the first cases report of TPP following epidural steroid injection.”
    Quote in the paperSubstantial claim
  • Findingown data

    The patient had a low urine potassium to creatinine ratio of 7.61 mEq/g (0.81 mEq/mmol).

    “The patient in this report had a low urine K/Cr ratio of 7.61 mEq/g (0.81 mEq/mmol), which ruled out renal loss as a possible etiology.”
    Quote in the paperSubstantial claim
  • Findingnone given

    A review of the literature identified one reported case of paralysis associated with hypokalemia following epidural steroid injection.

    “A review of the literature identified one reported case of paralysis associated with hypokalemia following epidural steroid injection.”
    Quote in the paperSubstantial claim
  • Findingnone given

    The patient's laboratory investigations were diagnostic of Graves' disease.

    “The patient’s laboratory investigations were diagnostic of Graves’ disease.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Steroids are a relatively rarely reported trigger for TPP.

    “Steroids are a relatively rarely reported trigger for TPP, and when they are involved, they are usually administered intravenously with the most common steroid being methylprednisone (Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Table 2

      Not checked in the free run.

  • May combine two claims. 19
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingcitation

    There has been one reported case of hypokalemic paralysis following epidural steroid injection, but this was not associated with thyrotoxicosis.

    “However, there has been one reported case of hypokalemic paralysis following epidural steroid injection, but this was not associated with thyrotoxicosis, and there have been other reports of paralysis following epidural steroid injection, including trauma and hemorrhage [7,8].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    On examination, power was 1/5 in both lower limbs and 4/5 in his upper limbs.

    “Power was 1/5 in both lower limbs and 4/5 in his upper limbs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The patient in this report had some risk factors for the development of TPP, including hyperglycemia, hypertestosteronemia, steroid injection, and being a young adult male of Asian origin.

    “The patient in this report had some risk factors for the development of TPP, including hyperglycemia, hypertestosteronemia, steroid injection, and being a young adult male of Asian origin.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The patient's serum testosterone level of 784 ng/dl represents hypertestosteronemia (elevated testosterone).

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected.

    “In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Four hours after the epidural steroid injection, the patient noticed that his legs became weak, and he collapsed.

    “Four hours after the epidural steroid injection, the patient noticed that his legs became weak, and he collapsed to the floor while urinating in the bathroom at his home.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The patient had a rapid recovery and an early discharge from hospital.

    “He had a rapid recovery and an early discharge from hospital.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The weakness in the legs was more severe than that in his upper extremities.

    “The weakness in the legs was more severe than that in his upper extremities, which allowed him to crawl back to his bedroom.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    When steroids trigger TPP, they are usually administered intravenously, most commonly methylprednisone.

    “Steroids are a relatively rarely reported trigger for TPP, and when they are involved, they are usually administered intravenously with the most common steroid being methylprednisone (Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Table 2

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Further investigations led to the diagnosis of hyperthyroidism and Graves' disease.

    “Further investigations led to the diagnosis of hyperthyroidism and Graves’ disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The case reported by Tahmasbi Sohi et al. was similar to ours regarding gender, latency of symptom development, and patient management.

    “This case was similar to ours regarding gender, the latency of symptom development, and patient management [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Tahmasbi Sohi M Sullivan WJ Anderson DJM Transient hypokalemic quad-riplegia after a lumbar transforaminal epidural dexamethasone injection: A case report PM R 2018 10 5 544 47 29074369

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    He was able to ambulate with assistance within six hours of treatment and was back to baseline potassium levels within nine hours of treatment.

    “He was able to ambulate with assistance within six hours of treatment and was back to baseline potassium levels within nine hours of treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient had a testosterone level of 784 ng/dl one month prior.

    “Laboratory results at that time showed a thyroid stimulating hormone (TSH) level of 0.100 mciu/ml and a testosterone level of 784 ng/dl.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient's potassium level one month prior was 3.7 mEq/L.

    “His potassium level at the time was 3.7 mEq/L.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    He was discharged with a diagnosis of TPP secondary to Graves' disease and treated with propranolol.

    “He was discharged from hospital with a diagnosis of thyrotoxic periodic paralysis (TPP) secondary to Graves’ disease and treated with propranolol.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Aldosterone was 9.5 ng/dl.

    “Aldosterone was 9.5 ng/dl, urine potassium was 12.8 mEq/L, urine creatinine was 168.22 mg/dL (14.87 mmol/L) and the urine potassium to creatinine ratio was 7.61 mEq/g (0.81 mEq/mmol).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient was unaware of the test results, as he was awaiting a follow-up visit at the time of the episode of paralysis.

    “The patient was unaware of the test results, as he was awaiting a follow-up visit at the time of the episode of paralysis that resulted in his hospital admission.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    MRI of the lumbar spine showed bulging intervertebral discs but no nerve impingement or other causes for his paraplegia.

    “Magnetic resonance imaging (MRI) of his lumbar spine showed bulging intervertebral discs but no nerve impingement or other causes for his paraplegia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of TPP in the United States is unknown.

    “Although the incidence of TPP in the United States is unknown, published reviews and case report indicate that the incidence may be on the rise due to changing demographics [4,6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Patel H Wilches LV Guerrero J Thyrotoxic periodic paralysis: Diversity in America J Emerg Med 2014 46 6 760 62 24315723

      Not checked in the free run.

    • cites [6] Kelley DE Gharib H Kennedy FP Thyrotoxic periodic paralysis: Report of 10 cases and review of electromyographic findings Arch Intern Med 1989 149 11 2597 600 2818118

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other reports of paralysis following epidural steroid injection include trauma and hemorrhage.

    “However, there has been one reported case of hypokalemic paralysis following epidural steroid injection, but this was not associated with thyrotoxicosis, and there have been other reports of paralysis following epidural steroid injection, including trauma and hemorrhage [7,8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Manchikanti L Hirsch JA Neurological complications associated with epidural steroid injections Curr Pain Headache Rep 2015 19 5 482 25795154

      Not checked in the free run.

    • cites [8] Abram SE O’Connor TC Complications associated with epidural steroid injections Reg Anesth 1996 21 2 149 62 8829408

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A mineralocorticoid effect of the injected steroid can lead to hypokalemia via increased urinary excretion.

    “The third possible mechanism is a mineralocorticoid effect of the injected steroid leading to hypokalemia via increased urinary excretion [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] van Buren M Rabelink TJ Koppeschaar HPF Koomans HA Role of glucocorticoid in excretion of an acute potassium load in patients with Addison’s disease and panhypopituitarism Kidney Int 1993 44 5 1130 38 8264146

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the case reported by Tahmasbi Sohi et al., epidural steroid injection was performed with dexamethasone.

    “In the case reported by Tahmasbi Sohi et al., epidural steroid injection was performed with dexamethasone [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Tahmasbi Sohi M Sullivan WJ Anderson DJM Transient hypokalemic quad-riplegia after a lumbar transforaminal epidural dexamethasone injection: A case report PM R 2018 10 5 544 47 29074369

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other potential causes of paralysis in this patient could have included conus medullaris syndrome from infarction, or an epidural hematoma.

    “Other potential causes of paralysis in this patient could have included conus medullaris syndrome from infarction [28], or an epidural hematoma, all of which have been reported as causes of paralysis after epidural steroid injection [7,8].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] Tackla RD Keller JT Ernst RJ Conus medullaris syndrome after epidural steroid injection: Case report Int J Spine Surg 2012 6 29 33 25694868 PMC4300874

      Not checked in the free run.

    • cites [7] Manchikanti L Hirsch JA Neurological complications associated with epidural steroid injections Curr Pain Headache Rep 2015 19 5 482 25795154

      Not checked in the free run.

    • cites [8] Abram SE O’Connor TC Complications associated with epidural steroid injections Reg Anesth 1996 21 2 149 62 8829408

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The most common triggers for TPP are high carbohydrate diet, alcohol, and exercise.

    “Many triggers for TPP have been identified, with the most common being high carbohydrate diet, alcohol, and exercise [30,31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Amblee A Gulati S Thyrotoxic periodic paralysis: Eight cases in males of Hispanic origin from a single hospital AACE Clin Case Rep 2015 2 1 e58 64

      Not checked in the free run.

    • cites [31] Chang C-C Cheng C-J Sung C-C A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants Eur J Endocrinol 2013 169 5 529 36 23939916 PMC3789562

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hypertestosteronemia creates an environment for the development of TPP as it increases muscle bulk and can induce the expression of Na/K ATPase in muscles, thereby explaining the increased incidence of TPP in men, although women have a higher incidence of Graves' disease.

    “Hypertestosteronemia also creates an environment for the development of TPP as it increases muscle bulk and can induce the expression of Na/K ATPase in muscles, thereby explaining the increased incidence of TPP in men, although women have a higher incidence of Graves’ disease [29,31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Lin S-H Huang C-L Mechanism of thyrotoxic periodic paralysis J Am Soc Nephrol 2012 23 6 985 88 22460532 PMC3358768

      Not checked in the free run.

    • cites [31] Chang C-C Cheng C-J Sung C-C A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants Eur J Endocrinol 2013 169 5 529 36 23939916 PMC3789562

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    TPP is reported to be more common in Asian males.

    “Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which is reported to be more common in Asian males [4,6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Patel H Wilches LV Guerrero J Thyrotoxic periodic paralysis: Diversity in America J Emerg Med 2014 46 6 760 62 24315723

      Not checked in the free run.

    • cites [6] Kelley DE Gharib H Kennedy FP Thyrotoxic periodic paralysis: Report of 10 cases and review of electromyographic findings Arch Intern Med 1989 149 11 2597 600 2818118

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The case reported by Tahmasbi Sohi et al. differed from ours by the absence of thyrotoxicosis, with hypokalemia solely attributed to direct effects of steroids and hyperglycemia.

    “What distinguishes the case presented in this report from the case reported by Tahmasbi Sohi et al. is the absence of thyrotoxicosis, with the hypokalemia in their case solely attributed to the direct effects of the steroids and hyperglycemia [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Tahmasbi Sohi M Sullivan WJ Anderson DJM Transient hypokalemic quad-riplegia after a lumbar transforaminal epidural dexamethasone injection: A case report PM R 2018 10 5 544 47 29074369

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In this patient, conus medullaris syndrome and epidural hematoma were unlikely given the time course of his symptoms and the resolution of paralysis after potassium replacement.

    “However, in this patient, these diagnoses were unlikely given the time course of his symptoms and the resolution of paralysis after potassium replacement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The procedure in the case reported here was done at another hospital, and external records of the nature and dose of steroid used were unavailable.

    “Unfortunately, the procedure in the case reported here was done at another hospital, and we were unable to acquire external records of the details of the nature of the steroid used and the dose administered.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed.

    “If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    This patient had an initial overcorrection of his potassium, which supports that caution is needed during potassium correction in TPP.

    “This patient had an initial overcorrection of his potassium, which supports that caution is needed during potassium correction in TPP.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Systemic effects of steroids after epidural steroid injections are not uncommon and can have significant effects on metabolism.

    “Systemic effects of steroids after epidural steroid injections are not uncommon and can have significant effects on metabolism [14–16].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14] Abdul AJ Ghai B Bansal D Hypothalamic pituitary adrenocortical axis suppression following a single epidural injection of methylprednisolone acetate Pain Physician 2017 20 7 E991 1001 29149147

      Not checked in the free run.

    • cites [15] Goel AP Nguyen VH Hamill-Ruth R Use of a risk-stratification tool in identification of potential adrenal suppression preceding steroid injection therapy in chronic pain patients Pain Med 2015 16 12 2226 34 26243057

      Not checked in the free run.

    • cites [16] Horani MH Silverberg AB Secondary Cushing’s syndrome after a single epidural injection of a corticosteroid Endocr Pract 2005 11 6 408 10 16638729

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of TPP may be on the rise in the United States due to changing demographics.

    “Although the incidence of TPP in the United States is unknown, published reviews and case report indicate that the incidence may be on the rise due to changing demographics [4,6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Patel H Wilches LV Guerrero J Thyrotoxic periodic paralysis: Diversity in America J Emerg Med 2014 46 6 760 62 24315723

      Not checked in the free run.

    • cites [6] Kelley DE Gharib H Kennedy FP Thyrotoxic periodic paralysis: Report of 10 cases and review of electromyographic findings Arch Intern Med 1989 149 11 2597 600 2818118

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is likely that the paralysis from TPP is mediated by sudden and transient hypokalemia.

    “It is likely that the paralysis from TPP is mediated by sudden and transient hypokalemia.”
    Quote in the paperNot a substantial claim
33 of 33

  • The paper relies on this without support.

    The patient's serum testosterone level of 784 ng/dl represents hypertestosteronemia (elevated testosterone).

    “The patient in this report had some risk factors for the development of TPP, including hyperglycemia, hypertestosteronemia, steroid injection, and being a young adult male of Asian origin.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There are few published cases of glucocorticoid administration prior to TPP.

    “There are few published cases of glucocorticoid administration prior to TPP, thus the possibility that glucocorticoids may precipitate TPP requires further investigation.”

    From Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study (2023) · cites this paper as [16]

  • From the current review of the literature, there are at least 13 cases of TPP associated with glucocorticoid use.

    “From the current review of the literature, there are at least 13 cases of TPP associated with glucocorticoid use [13-16].”

    From Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study (2023) · cites this paper as [16]

  • Glucocorticoid treatment for Graves' ophthalmopathy or thyroid storm may precipitate TPP via a negative feedback mechanism.

    “Glucocorticoid treatment for Graves’ ophthalmopathy or thyroid storm may precipitate TPP via a negative feedback mechanism [16].”

    From Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study (2023) · cites this paper as [16]

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 2

  1. [3]Weber F Lehmann-Horn F Hypokalemic periodic paralysis. 2002 4 30 Adam MP Ardinger HH Pagon RA GeneReviews® [Internet] Seattle (WA) University of Washington Seattle; 1993–2018. Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK1338/ 20301512
  2. [20]Genek DG Huddam B Karakuş V Glucocorticoid-induced hypokalemic periodic paralysis in subclinical hyperthyroidism: Case report Medical Journal of Mugla Sitki Kocman University 2016 3 3 32 34

Cited by

Sorted by citations

Related

Authors
Affram, K. O., Reddy, T. L., & Osei, K. M.
Affiliations
Piedmont Athens Regional (US)
Corresponding author
Osei, Kofi M.
ORCID
Affram, Kwame Ofori
Venue
American Journal of Case Reports
Publisher
International Scientific Information, Inc.
Published
2018-12-08
Volume
19
Pages
1453-1458
ISSN
1941-5923 (ISSN-L)
DOI
10.12659/ajcr.911270
PMC
PMC6293861
OpenAlex
W2903792611
Semantic Scholar
26d646b91f52b0484ef0e5f5eeb3a9554aba17d5
Cited by
13
References
29
Citations by year
2025: 2 · 2023: 3 · 2022: 2 · 2021: 5 · 2019: 1
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • American Journal of Case Reports (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
  • Health Sciences › Medicine › Surgery › Medical Case Reports and Studies
Keywords
thyrotoxic periodic paralysis, epidural steroid injection complications, hypokalemia, hyperthyroidism, Graves' disease, potassium correction
MeSH terms
Adult, Glucocorticoids, Graves Disease, Humans, Hypokalemia, Injections, Epidural, Male, Paralysis, Thyrotoxicosis

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