Hyperthyroidism with periodic paralysis, acropachy, pre-tibial myxoedema, transient atrial fibrillation and myopathy.

Periodic paralysis, idiopathic atrial fibrillation, acropachy, manic depressive illness, skeletal manifestations, pernicious anaemia and pre-tibial myxoedema have all been separately reported in association with thyrotoxicosis. It is very unusual to encounter a patient with many of the complications. In Singapore thyrotoxic periodic paralysis is relatively common (6.0% of all thyrotoxics) while pre-tibial myxoedema is rare (0.7% of all thyrotoxics). The association of the two conditions in a patient has not been described previously. We report in this paper a patient with hyperthyroidism presenting with periodic paralysis who subsequently developed acropachy, transient atrial fibrillation, pre-tibial myxoedema and myopathy.