Patients presenting to the emergency department with paralysis can have a wide differential diagnosis. Thyrotoxic periodic paralysis (TPP) is a rare disorder causing transient flaccid paralysis in the setting of thyrotoxicosis and hypokalemia. It has been reported in Asian male populations predominantly, and the diagnosis is rarely considered in non-Asian populations. Recent research has identified cases in patients with diverse ethnic backgrounds, although epidemiologic data from the United States are very limited.
Our aim was to report our experience with TPP at a tertiary care center in the United States.
A retrospective chart review was conducted between January 2006 and February 2022 to identify cases of TPP and determine their demographic and clinical characteristics. Prevalence of TPP was estimated using the institutional hyperthyroidism registry.
Thirty-three patients with TPP were identified. All of the patients were male; median age was 28 years, and 85% were Hispanic. All patients had hypokalemia at presentation and 23% had rebound hyperkalemia after treatment. Prevalence of TPP in our population of patients with hyperthyroidism was approximately 0.5%.
Young Hispanic men presenting with paralysis should be evaluated for TPP, as the prevalence in this population may be higher than estimated previously. Management of TPP involves treatment of underlying hyperthyroidism and cautious potassium repletion, with an initial dose of no more than 60 mEq/L of potassium chloride to avoid rebound hyperkalemia.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Thyrotoxic Periodic Paralysis.StatPearls, 2022
- Clinical lectures on Grave's disease.Lancet. 1890;
- A syndrome resembling familial periodic paralysis occurring in the course of exophthalmic goiter.Endocrinology. 1931; 15: 541-546
- Periodic paralysis complicating thyrotoxicosis in Chinese.Br Med J. 1967; 1: 451-455
- Periodic paralysis and voltage-gated ion channels.Kidney Int. 1996; 49: 9-18
- A mutation in the KCNE3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis.J Clin Endocrinol Metab. 2002; 87: 4881-4884
- Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis.Cell. 2010; 140: 88-98
- Identification and functional characterization of Kir2.6 mutations associated with non-familial hypokalemic periodic paralysis.J Biol Chem. 2011; 286: 27425-27435
- Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings.Arch Intern Med. 1989; 149: 2597-2600
- Comparison of the incidence of association of periodic paralysis and hyperthyroidism in Japan in 1957 and 1991.Endocrinol Jpn. 1992; 39: 315-318
- Thyrotoxic periodic paralysis.Mayo Clin Proc. 2005; 80: 99-105
- Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes.Arch Intern Med. 1999; 159: 601-606
- Thyrotoxic periodic paralysis: eight cases in males of Hispanic origin from a single hospital.AACE Clin Case Rep. 2016; 2: e58-e64https://doi.org/10.4158/EP14578.CR
- Thyrotoxic periodic paralysis and complicated thyrotoxicosis, two presentations of hyperthyroidism with notable differences in their clinical manifestations: an experience from a tertiary care hospital in the United States.Endocr Pract. 2020; 26: 699-706
- Thyrotoxic periodic paralysis: a retrospective, observational study from India.Indian J Med Res. 2020; 151: 42-46
- A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants.Eur J Endocrinol. 2013; 169: 529-536
- Hypokalemic periodic paralysis: a case series, review of the literature and update of management.Eur J Emerg Med. 2010; 17: 45-47
- Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks.Eur J Neurol. 2008; 15: 559-564
- Thyrotoxic, hypokalaemic periodic paralysis: Polynesians, an ethnic group at risk.Intern Med J. 2007; 37: 303-307
- Thyrotoxic periodic paralysis in a Chinese population.QJM. 1996; 89: 463-468
- Thyrotoxic hypokalemic periodic paralysis: 18 cases with different forms of thyrotoxicosis.Rev Clin Esp. 1995; 195 ([in Spanish]): 294-297
- Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature.Medicine (Baltimore). 1992; 71: 109-120
- In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis.BMJ. 1991; 303: 1096-1099
- Changing management guidelines in thyrotoxic hypokalemic periodic paralysis.J Emerg Med. 2018; 55: 252-256
Published online: October 28, 2022
Accepted: October 21, 2022
Received in revised form: September 13, 2022
Received: July 15, 2022
© 2022 Elsevier Inc. All rights reserved.