Distal renal tubular acidosis and hypokalemic paralysis in a patient with hypothyroidism

Abstract EN

A 43-year-old woman on treatment for primary hypothyroidism presented with 1-day progressive weakness of all her limbs and history of similar episodes in the past.

Clinical examination revealed grade 2 hypo reflexive weakness.

Investigations revealed features of hypokalemia, metabolic acidosis, alkaline urine, and a fractional bicarbonate excretion of 3.5%, consistent with distal renal tubular acidosis.

Ant thyroid peroxidase and antithroglobulin antibodies were positive, suggesting an autoimmune basis for the pathogenesis of the functional tubular defect.

Bicarbonate therapy resulted in a sustained clinical recovery.