Comparison of the Incidence of Association of Periodic Paralysis and Hyperthyroidism in Japan in 1957 and 1991.

Shizume, Kazuo; Shishiba, Yoshimasa; Kuma, Kanji; Noguchi, Shiro; Tajiri, Junichi; Ito, Kunihiko; Noh, Jaeduk Yoshimura

doi:10.1507/endocrj1954.39.315

Cited by 40 publications

(26 citation statements)

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“…Indeed, THPP has been reported to occur in 4.3% to 8.2% of hyperthyroid Japanese males [1,12] and 12.9% of hyperthyroid Chinese males [2]. The association of paralysis with thyrotoxicosis is infrequent in the Caucasian population and to the best of our knowledge this is the first Turkish patient with THPP in English literature.…”

Section: Discussionmentioning

confidence: 80%

Thyrotoxic Periodic Paralysis in a Turkish Male; The Recurrence of the Attack after Radioiodine Treatment

et al. 2005

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Abstract. Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism and an uncommon form of hypokalemic periodic paralysis. Its differentiation of more common forms of periodic paralysis is important because aggressive treatment can place the patient at risk for rebound hyperkalemia. Treatment of the underlying thyroid dysfunction cures the muscle symptoms. Here we describe a 37-year-old Turkish male with THPP whose paralysis attack recurred soon after administration of radioactive iodine. THYROTOXIC hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism in the Western population. It occurs primarily in males of Asian descent, including patients of Japanese, Chinese, Vietnamese, Korean, Filipino, American Indian, and Hispanic ancestry [1][2][3][4][5][6][7][8][9][10]. Although the association of thyrotoxicosis and periodic paralysis has been wellknown since 1931 [11] it is not reported from Turkey in English literature, most probably because of unfamiliarity with the disorder. We herein report a 37-year-old Turkish male patient with THPP who also experienced a paralysis attack ten days after the administration of radioiodine despite the treatment with propranolol. Case reportA 37-year-old Turkish male patient presented with the complaint of approximately ten episodes of muscle weakness for 2 years. These attacks occurred in all but one episode at night, following exertion or consumption of large carbohydrate meals. He was usually awakened from sleep in the early hours with difficulty of ambulation due to muscle weakness of extremities mainly in his legs. There were no prodromal symptom and no seasonal variation of the attacks. The duration of paralysis attacks ranged from four to 24 hours. He didn't seek medical attention for the paralysis attacks and they all resolved spontaneously. There was no family history of neuromuscular and endocrine abnormality.He was diagnosed as having hyperthyroidism based on the clinical symptoms of occasional palpitation and nervousness and the suppressed thyroid stimulating hormone (TSH) of 0.01 mU/mL (normal, 0.35-4.5 mU/ mL) five months ago. Then he was put on carbimazole therapy (20 mg daily). After the cessation of therapy by his own decision approximately one month ago, he experienced another attack. He denied any weight loss, heat intolerance, or diarrhea. The physical examination including muscle strength and tendon reflexes was unremarkable.His free thyroxine (FT 4 ) level was 5.26 ng/dL (normal, 0.8-1.9 ng/dL) and TSH level was <0.002 mU/mL (normal, 0.4-5.0 mU/mL). The TSH-receptor-stimulating antibody level was 135 U/L (normal, 0-9 U/L). Thyroid scan revealed diffuse uptake in a normal sized gland with a 24-hour radioactive iodine uptake of 52.1%. These findings were found to be most con-

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Section: Discussionmentioning

confidence: 80%

Thyrotoxic Periodic Paralysis in a Turkish Male; The Recurrence of the Attack after Radioiodine Treatment

et al. 2005

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“…Thus, further extensive studies are clearly required to elucidate the mechanism of TPP. While the frequency of TPP remains largely unknown but is reportedly very low in Western countries, it is obviously high in Asian populations [1][2][3]. The reason for the difference remains undefined.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for such rarity remains unknown. TPP is common in Asian populations; the incidence of TPP is reported-ly 1.9% in Japan [2,3]. In contrast, TPP is less common in western countries; its incidence is reportedly 0.1-0.2% in thyrotoxic patients [1].…”

Section: Discussionmentioning

confidence: 99%

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Autonomously Functioning Thyroid Nodule Associated with Thyrotoxic Periodic Paralysis

et al. 2008

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Abstract. Thyrotoxic periodic paralysis (TPP) is mainly associated with Graves' disease but rarely with autonomously functioning thyroid nodule (AFTN). We herein report a case of AFTN associated with TPP in which the latter resolved after 131 I therapy for the former. We analyzed the genes encoding thyrotropin receptor (TSHR), the α-subunit of the stimulatory G protein (Gsα), calcium channel CACNA1S and potassium channel KCNE3, and found that the patient does not carry the known mutations in these genes. Whereas the pathogenesis of TPP and AFTN remains to be understood, the present case suggests that ion channel defects responsible for familial hypokalemic periodic paralysis may not be associated with TPP, and that mutations in TSHR and Gsα genes may be less frequent in AFTN patients in the Japanese population.

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“…Overall, the male to female ratio ranges from 17:1 to 70:1 (1,2,7,8) . Patients with TPP usually experience the attack a few hours after a heavy meal or in the early morning upon waking: more than two thirds of patients present to the emergency department between 2100 and 0900 h. Such timing of presentation led the condition to be initially described as nocturnal paralysis or night palsy (9,22) . Patients may give a history of similar but milder attacks before presentation.…”

Section: Hyrotoxic Periodic Paralysis (Tpp)mentioning

confidence: 99%

Thyrotoxic Periodic Paralysis: Diagnosis, Management and Role of Propranolol in Treatment

Saeed

Fathy

et al. 2013

Zagazig University Medical Journal

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Background: Hypokalemia is commonly encountered during paralysis in patients with thyrotoxic periodic paralysis (TPP) and may contribute to neuromuscular manifestations. This condition mainly affects male patients of Asian descent. With increasing population mobility and admixture, TPP as the presenting feature of hyperthyroidism is more common in Western countries and Gulf area. TPP is an alarming and potentially lethal complication of hyperthyroidism characterized by muscle paralysis and hypokalemia due to a massive intracellular shift of potassium. A potassium supplement has been recommended to hasten recovery and prevent cardiopulmonary complications. However, this recommendation has not yet proven efficacious. Hyperadrenergic activity has been implicated in the pathogenesis of TPP. We tested whether nonselective β-blockers could terminate neuromuscular symptoms rapidly while reducing an intracellular shift of potassium. Methods: We describe 7 patients who had an acute attack of TPP with characteristic hypokalemia. Results: After oral propranolol, 3 mg/kg, serum potassium concentrations increased promptly in all patients, and there was complete amelioration of paralysis. Only 3 patient needed short term K supplement for their sever hypokalemia and sever symptoms. No rebound hyperkalemia was detected. Conclusion: Given propranolol efficacy in this study, propranolol should be considered as a first-line therapy for TPP.

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Comparison of the Incidence of Association of Periodic Paralysis and Hyperthyroidism in Japan in 1957 and 1991.

Cited by 40 publications

References 5 publications

Thyrotoxic Periodic Paralysis in a Turkish Male; The Recurrence of the Attack after Radioiodine Treatment

Thyrotoxic Periodic Paralysis in a Turkish Male; The Recurrence of the Attack after Radioiodine Treatment

Autonomously Functioning Thyroid Nodule Associated with Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis: Diagnosis, Management and Role of Propranolol in Treatment

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