Critical Care and Shock

Hyperthyroidism Presenting as Acute Muscular Weakness

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A 25 year-old Hispanic gentleman without any significant past medical history, presented to the emergency department with a 3 hour history of sudden onset shortness of breath and acute progressive quadriparesis. He specifically denied any recent viral infection, recent travel or illicit drug use. He worked as a “chef” in a local restaurant. On initial physical examination, the patient was a slender male in moderate-to-severe respiratory distress. Blood pressure was 160/90 mmHg, heart rate 150 bpm, respiratory rate 32/minute, temperature 38.5 ºC and oxygen saturation by pulse oximetry of 98%. Bilateral exoph thalmos was noted and homogenous enlargement of thyroid gland palpated without tenderness. Lung examination was unremarkable despite his respiratory distress. Heart sounds were normal and no murmurs were heard. Muscle strength in the lower extremities was 0/5, and upper extremities were 2/5. Sensory system examination and deep tendon reflexes appeared within normal limits.

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