Thioredoxin-interacting protein (TXNIP) emerges as a central regulator for glucose homeostasis, which goes awry in diabetic subjects. Endothelial dysfunction is considered the earliest detectable stage of cardiovascular disease (CVD), a major complication of diabetes. Here, we hypothesize that TXNIP may promote endothelial dysfunction seen in Type 1 diabetes mellitus (T1D). Using a T1D-like rat model, we found that diabetic rats showed significantly higher TXNIP mRNA and protein levels in peripheral blood, compared to their non-diabetic counterparts. Those changes were accompanied by decreased production of nitric oxide (NO) and vascular endothelial growth factor (VEGF), concurrent with increased expression of reactive oxygen species (ROS) and vascular cell adhesion molecule 1 (VCAM-1) in the aortic endothelium. In addition, TXNIP overexpression in primary human aortic endothelial cells (HAECs) induced by either high glucose or overexpression of carbohydrate response element binding protein (ChREBP), a major transcriptional activator of TXNIP, promoted early apoptosis and impaired NO bioactivity. The correlation between TXNIP expression levels and endothelial dysfunction suggests that TXNIP may be a potential biomarker for vascular complications in T1D patients.

Thyrotoxic periodic paralysis (TPP) is an uncommon hyperthyroidism-related condition characterized by abrupt onset muscle weakness and hypokalemia resulting from rapid intracellular shift of potassium. TPP is primarily reported in adult males in Asian populations, including Chinese, Japanese, Vietnamese, Filipino, and Korean. 1,2 Its incidence in non-Asian populations such as Caucasians, African Americans, and Hispanics is very low. PTT is very rarely seen in the pediatric population. 3 A number of TPP cases in adults have been reported in Western countries recently. TPP is commonly misdiagnosed in Western countries because of its similarities to familial periodic paralysis. 4 We report a case of an Asian adolescent male presenting with acute-onset paralysis and severe hypokalemia and highlight the importance of recognizing TPP.

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