Comment on the diagnosis of this patient with hypokalemic periodic paralysis.

Ans. (c) Grave's disease.* Thyrotoxicosis is sometimes associated with a form of hypokalemic periodic paralysis; this disorder is particularly common in Asian males with thyrotoxicosis.* Lid retraction, causing a staring appearance, can occur in any form of thyrotoxicosis and is the result of sympathetic overactivity.* However, Graves' disease is associated with specific eye signs that comprise Graves' ophthalmopathy* Many scoring systems have been used to gauge the extent and activity of the orbital changes in Graves' disease. The "NO SPECS" scheme is an acronym derived from the following eye changes:0 = No signs or symptoms1 = Only signs (lid retraction or lag), no symptoms2 = Soft-tissue involvement (periorbital edema)3 = Proptosis (>22 mm)4 = Extraocular-muscle involvement (diplopia)5 = Corneal involvement6 = Sight loss