“Hashitoxicosis” and possible acquired Gitelman syndrome: dual pathology leading to a catastrophic hypokalemic periodic paralysis

Thyrotoxic periodic paralysis (TPP) is more commonly seen in Graves’ disease. But TPP can occur in any condition leading to a hyperthyroid state. It’s important to identify the underlying aetiology of the thyrotoxic state as the management differs with the aetiology in the long run. Here we present a case of Hashimoto thyroiditis presenting with hypokalemic periodic paralysis as the first manifestation of the disease along with possible coexisting Gitelman syndrome (GS) aggravating the hypokalemic status leading to a catastrophic periodic paralysis.