Periodic Paralysis as a New Phenotype of Resistance to Thyroid Hormone Syndrome in a Chinese Male Adult

Abstract

Context:

A majority of patients with resistance to thyroid hormone (RTH) are asymptomatic, whereas some patients show signs of hyperthyroidism, or hypothyroidism, or both. Thyrotoxic periodic paralysis is the most common form of acquired periodic paralysis. However, it has not been reported in a patient with RTH up to now.

Objective:

We evaluated a 36-year-old male patient from China with elevated serum free T ₄ and free T ₃ and inappropriately high TSH who presented with periodic paralysis.

Study Design:

Clinical, biochemical, and radiological assessments, as well as DNA sequencing, were performed.

Results:

The patient's laboratory tests revealed the following: TSH, 6.14 mIU/L (0.27–4.2 mIU/L); free T ₃, 12.85 pmol/L (2.8–7.1 pmol/L); free T ₄, 33.62 pmol/L (9.05–25.5 pmol/L); and serum SHBG, 19.4 nmol/L (18.3–54.1 nmol/L). No significant suppression of TSH was observed in the rapid TSH suppression test with somatostatin analogs. Compound muscle action potential after exercise of the patient was reduced by 58%. Sequencing of thyroid hormone receptor genes confirmed a C446S mutation in the THRβ gene.

Conclusions:

This is the first report of periodic paralysis as a new phenotype of RTH syndrome.