Abstract
Periodic paralysis hypokalemia is a muscle weakness that can be caused by hyperthyroidism due to Graves’ disease. The prevalence reaches 10% of patients with periodic paralysis hypokalemia with symptoms of thyrotoxicosis. Graves’ disease is an immune system disorder that can cause other organ dysfunction, such as autoimmune hepatitis. Currently, the diagnosis of autoimmune hepatitis is still a challenge for clinicians due to limited supporting examination facilities, such as SMA, AMA, anti-LKM-1. This article discusses a case of a 34-year-old woman with limb weakness for 3 months, losing 4 kg of weight in 1 month, often feeling hungry, restless, having trouble sleeping, unable to stand the heat, and palpitation. Her urine was looked like a tea color for the last 10 days. Laboratory examination results showed an increase in alanine transaminase (ALT) levels 256 U/I and aspartate aminotransferase (AST) 142 U/I, accompanied by an increase in total bilirubin levels of 12.09 mg/dl, direct bilirubin 10.5 mg/ dl. Markers of hepatitis B (HbsAg) and anti-HCV were negative. The potassium level was 2.29 mmol/L and the antinuclear antibody test was 1.3 IU/ml. Thyroid-stimulating hormone (TSH) <0.01 uIU/ml, and FT4 5.46 mg/dl. Abdominal ultrasound showed chronic liver disease. Histopathology of liver tissue showed chronic hepatitis with inflammatory infiltration. The patient had been treated with thiamazole, potassium supplements, propranolol, and prednisone. As a result, the patient’s condition and liver enzyme tests improved
References
1. Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli‐Vergani G, Vergani D, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51(6):2193-213. 2. Weber F, Lehmann-Horn F. Hypokalemic periodic paralysis [Internet]. GeneReviews®: Seattle University of Washington, Seattle; 2018. 3. Bartalena L. Graves’ disease: complications [Internet]. South Dartmouth, MA: MDText; 2018. 4. Kahaly G, Frommer L. Polyglandular autoimmune syndromes. J Endocrinol Invest. 2018;41(1):91-8. 5. Mieli-Vergani G, Vergani D, Czaja AJ, Manns MP, Krawitt EL, Vierling JM, et al. Autoimmune hepatitis. Nat Rev Dis Primers. 2018;4(1):1- 21. 6. Floreani A, Restrepo-Jiménez P, Secchi MF, De Martin S, Leung PS, Krawitt E, et al. Etiopathogenesis of autoimmune hepatitis. J Autoimmun. 2018;95:133-43. 7. Aggarwal A, Wadhwa R, Pande A, Sahu M, Kapoor D, Khanna R. Hypokalemic periodic paralysis and spectrum of thyroid disorders: Analysis of 7 cases from Northern India. Indian J Endocrinol Metab. 2019;23(1):168. 8. Smith S, Al-Lozi M. Thyrotoxic periodic paralysis: an unusual presentation of hyperthyroidism in a 20 year-old male. Neurology. 2019;92(Suppl 15):P5.4-020. 9. Kumar S, Offiong EE, Sangita S, Hussain N. Phenotypical variation with same genetic mutation in familial hypokalemic periodic paralysis. J Pediatr Neurosci. 2018;13(2):218. 10. Lam L, Nair RJ, Tingle L, editors. Thyrotoxic periodic paralysis. Proc (Bayl Univ Med Cent). 2006;19(2):126–9. 11. Salih M, van Kinschot C, Peeters R, de Herder W, Duschek E, van der Linden J, et al. Thyrotoxic periodic paralysis: an unusual presentation of hyperthyroidism. Neth J Med. 2017;75:315-20. 12. Fialho D, Griggs RC, Matthews E. Periodic paralysis. Handb Clin Neurol. 2018;148:505-20. 13. Ma S, Hu M, Yang H, Lian X, Jiang Y. Periodic paralysis as a new phenotype of resistance to thyroid hormone syndrome in a chinese male adult. J Clin Endocrinol Metab. 2016;101(2):349-52. 14. Cesur M, Gursoy A, Avcioglu U, Erdogan MF, Corapcioglu D, Kamel N. Thyrotoxic Hypokalemic Periodic Paralysis as the First Manifestation of Interferon-α–induced Graves Disease. J Clin Gastroenterol. 2006;40(9):863-5. 15. Didonna D, D’Alessandro G, De AM, Conte M, Storelli A, Totaro M, et al. Thyrotoxic periodic paralysis in a Caucasian man in treatment for Graves’ disease. Panminerva Med. 2000;42(4):293-4. 16. Patel K, McCoy JV, Davis PM. Recognizing thyrotoxic hypokalemic periodic paralysis. JAAPA. 2018;31(1):31-4. 17. Vanderpump M. Thyrotoxic periodic paralysis. In: Matfin G, editor. Endocrine and metabolic medical emergencies: a clinician’s guide, second edition. Hoboken, New Jersey: Wiley-Blackwell; 2018. p.296-304. 18. Smith TJ, Hegedüs L. Graves’ disease. N Engl J Med. 2016;375(16):1552-65. 19. Ichai P, Duclos‐Vallée JC, Guettier C, Hamida SB, Antonini T, Delvart V, et al. Usefulness of corticosteroids for the treatment of severe and fulminant forms of autoimmune hepatitis. Liver Transplant. 2007;13(7):996-1003. 20. Czaja A. The management of autoimmune hepatitis beyond consensus guidelines. Aliment Pharmacol Ther. 2013;38(4):343-64. 21. Malik TA, Saeed S. Autoimmune hepatitis: a review. J Pak Med Assoc. 2010;60(5):381-7
Recommended Citation
Larasati, Yeni and Wahono, C. Singgih
(2021)
"The Challenges of Diagnosis and Management of SuspectedAutoimmune Hepatitis in a 34-Year-Old Woman with PeriodicParalysis and Graves’ Disease,"
Jurnal Penyakit Dalam Indonesia: Vol. 8:
Iss.
4, Article 7.
DOI: 10.7454/jpdi.v8i4.424
Available at:
https://scholarhub.ui.ac.id/jpdi/vol8/iss4/7