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Abstract: TH-PO028

Bloodless Artificial Intelligence Electrocardiography Detecting Thyrotoxic Periodic Paralysis Following SARS-CoV-2 Infection

Session Information

Category: Augmented Intelligence, Digital Health, and Data Science

  • 300 Augmented Intelligence, Digital Health, and Data Science

Authors

  • Lu, Ang, Tri-Service General Hospital Department of Internal Medicine, Taipei, Taiwan
  • Chen, Chien-Chou, Tri-Service General Hospital Department of Internal Medicine, Taipei, Taiwan
  • Lin, Chin, National Defense Medical Center, Taipei, Taiwan
  • Wu, Tsung-Jui, Hualien Armed Forces General Hospital, Xincheng, Hualien, Taiwan
  • Lin, Shih-Hua P., Tri-Service General Hospital Department of Internal Medicine, Taipei, Taiwan
Introduction

Hypokalemic paralysis, a metabolic muscle paralysis emergency, is divided into hypokalemic periodic paralysis (HypoPP) due to acute intracellular K+ shift, and non-HypoPP due to profound K+ deficiency. Thyrotoxic periodic paralysis (TPP), a form of HypoPP, is characterized by acute muscle paralysis, hypokalemia, and hyperthyroidism and can be triggered by any kind of thyrotoxicosis and occasionally by viral infection. This case highlights a young Chinese male with TPP following SARS-CoV-2 infection, rapidly identified via artificial intelligence electrocardiography (AI-ECG).

Case Description

A 22-year-old man recently infected with SARS-CoV-2 presented with acute paralysis in his lower limbs and palpitations post-exercise. Examination showed symmetrical areflexia and an enlarged thyroid. AI-ECG detected hypokalemia and high TPP likelihood (Figure 1). Intravenous K+ supplementation began and subsequent test showed hypokalemia (1.6 mmol/L). Treatment with intravenous K+ normalized muscle strength and serum K+ while hormone studies confirmed Graves' disease. Hyperthyroidism was managed with antithyroid drug and β-blocker. He had subclinical hyperthyroidism without relapse 3 months later.

Discussion

Despite the incidence of COVID-19-related thyrotoxicosis, TPP following SARS-CoV-2 infection are rare. Rapid diagnosis and appropriate TPP management are vital. The implementation of AI-ECG system, featuring hypokalemia and TPP detection models, allows for rapid identification and treatment initiation. Given the high incidence and swift emergence of COVID-19-related hyperthyroidism, evaluations of thyroid function, electrolytes, and use of AI-ECG are warranted in patient with neuromuscular symptom to ensure early TPP detection and reduces serious complications.

(A) Prolonged QT interval and prominent U wave; (B, C) AI-ECG analysis indicates hypokalemia and high likelihood of TPP