Changing Management Guidelines in Thyrotoxic Hypokalemic Periodic Paralysis

Correia, Matthew S.; Darocki, M.; Hirashima, Eva Tovar

doi:10.1016/j.jemermed.2018.04.063

Cited by 16 publications

(14 citation statements)

References 22 publications

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“…Administering non-selective beta blockers such as propranolol will help reduce activity of the Na+/K+-ATPase, reduce insulin secretion, and correct the underlying cause, which is increased thyroid hormone (through reduction of T4 to T3) [10]. Dosing of propranolol can be 3 mg/kg PO, if patient can tolerate [11].…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis in a Young Hispanic Male With Newly Diagnosed Grave's Disease

Mabile¹,

Nezafati²

2021

Cureus

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Thyrotoxic periodic paralysis (TPP) is a unique cause of hypokalemia from transcellular shift into muscle in the setting of active thyrotoxicosis. It is essential to recognize TPP, given the specific management considerations, which would otherwise easily go unaddressed. TPP can also be clinically indistinguishable from other causes of hypokalemia. In particular, familial periodic paralysis can present similar to TPP. This case illustrates a young Hispanic male who presented with paralysis and was found to be hypokalemic. Patient was also found to have thyromegaly with further testing consistent with Grave's disease, despite no hyperthyroid symptoms. Ultimately, identifying TPP early will allow for swift and appropriate treatment, avoid unnecessary interventions and testing, and reduce cost of care.

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Section: Discussionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis in a Young Hispanic Male With Newly Diagnosed Grave's Disease

Mabile¹,

Nezafati²

2021

Cureus

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“…The latter is more commonly seen in the third to fourth decades of life and males [ 7 ]. In thyrotoxic periodic paralysis, the treatment emphasizes on potassium supplementation (limited to < 60 meq/day to avoid rebound hyperkalemia) and starting the patient on non-selective beta-blocker and anti-thyroid treatment medications like methimazole and propylthiouracil [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Muscle Paralysis as a Rare Cause of Reversible Muscle Weakness: A Case Report

Iqbal

Zia

Niazi

et al. 2020

Cureus

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Thyrotoxic periodic paralysis is a clinical condition characterized by muscle weakness in patients with underlying hyperthyroidism. It is usually more commonly seen in patients of Asian origin and has a predisposition for the male population (unlike other thyroid disorders which commonly affect the female population). Findings are more overt in patients who have subclinical hyperthyroidism and there is a risk of them remaining untreated. The symptoms can range from mild muscle weakness to total paralysis. The muscles affected predominantly are the proximal and lower extremities group of muscles. Thyrotoxic muscle paralysis can be precipitated by hyperinsulinemic states such as after heavy meals, physical exertion, obesity, stress, and certain medications like high-dose steroids, antiretrovirals, and interferon therapy. The acute intervention usually revolves around the replenishment of patient's potassium stores followed by maintenance therapy with anti-thyroid medications. We present a case of a Chinese adolescent who presented to us with lower muscle weakness and underlying subclinical hyperthyroidism. It's important for clinicians to be familiar with this disease entity and include it in their differentials whenever a patient with muscle weakness presents. The treatment is simple and can result in rapid improvement of symptoms and should be initiated quickly.

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“…Hypokalemia is a cardinal feature of TPP despite increasing reported unusual cases with normal serum potassium levels [15] , [16] . Close monitoring of serum potassium during treatment with intravenous potassium replacement was recommended to avoid rebound hyperkalemia [17] . The severity of TPP correlates with the level of serum potassium, not the severity of thyrotoxicosis [10] .…”

Section: Discussionmentioning

confidence: 99%

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis

Karndumri

Thewjitcharoen

Chatchomchuan

et al. 2020

Journal of Clinical & Translational Endocrinology

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Background Thyrotoxic periodic paralysis (TPP) is a unique manifestation of Graves’ disease. While it is uncommon in Asian, it is extremely rare in Caucasian patients (0.1–0.2%). Previous studies suggested that TPP indicate more severity of Graves’ disease and definitive treatments should be used to prevent relapses. Aim To describe clinical features and impact of first-line treatment on long-term outcomes of TPP patients. Method A retrospective cohort study over 35 years (1985–2019) of TPP from Graves’ disease patients was conducted. All cases were analyzed and their clinical courses were compared between those who received anti-thyroid drugs (ATD) versus radioactive iodine (RAI) as a primary treatment. None of them underwent surgery. Results A total of 2964 hyperthyroid Graves’ disease patients were treated and followed-up at least 3 months over the study period. TPP was identified in 63 cases (2.1%) of all patients. There were 60 males and only 3 females with age at presentation of 35.0 ± 8.2 years. TPP was the first presentation of hyperthyroid Graves’ disease in 82.5% of them. During the acute attack of TPP, all patients presented with bilateral lower limb flaccid weaknesses with median serum potassium of 2.1 mmol/L. No fatal TPP cases were found. RAI was selected as primary treatment in 27 patients (42.9%). Nearly all RAI-treated patients rendered hypothyroidism with the median RAI dose at 15 mCi. No patients who were in remission after RAI treatment developed recurrent attack of TPP. In the remaining 36 ATD-treated patients with mean follow-up time at 9.1 years, relapse was found in 10 patients (27.8%) after the drug discontinuation and 6 patients suffered recurrent TPP. Only 8 ATD-treated TPP patients (22.2%) went into remission. Conclusions TPP is a rare complication of hyperthyroid Graves’ disease. Definitive treatment with RAI or thyroidectomy should be employed to prevent relapse and further attacks of TPP.

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Changing Management Guidelines in Thyrotoxic Hypokalemic Periodic Paralysis

Cited by 16 publications

References 22 publications

Thyrotoxic Periodic Paralysis in a Young Hispanic Male With Newly Diagnosed Grave's Disease

Thyrotoxic Periodic Paralysis in a Young Hispanic Male With Newly Diagnosed Grave's Disease

Thyrotoxic Muscle Paralysis as a Rare Cause of Reversible Muscle Weakness: A Case Report

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis

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