Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings

Kelley, David E.; Gharib, Hossein; Kennedy, Frank P.; Duda, Ralph J.; McManis, Philip G.

doi:10.1001/archinte.149.11.2597

Cited by 131 publications

(167 citation statements)

References 31 publications

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“…It occurs in about 0.1 to 0.2% of the hyperthyroid population in North America, and it is 10 times more frequent in the Oriental population and in males. 1 The age of onset is usually in the third decade of life. 2 The high incidence of this disorder in Asians and the association with the presence of HLA-DRw8 suggests that the basic defect may be genetically determined, but the precise pathogenesis of TPP remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The onset of paralytic attacks usually coincides with the onset of hyperthyroidism, although symptoms, if present, are often mild. 1,3 Some electrocardiogram features that can suggest a diagnosis of TPP are the triad of sinus tachycardia attributable to the hyperadrenergic state, prolonged QT-U interval attributable to hypokalemia, and a paradoxically prolonged PR interval due to the thyrotoxicosis. 12 The differential diagnosis for TPP includes familial hypokalemic periodic paralysis (FHPP).…”

Section: Discussionmentioning

confidence: 99%

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Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Barahona¹,

Vinagre²,

Sojo³

et al. 2009

Clinical Medicine & Research

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Case ReportThyr otoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. TPP is often not recognized at first attack due to a very low prevalence among the Caucasian population and usually mild symptoms of hyperthyroidism. We report a case of TPP due to Graves' disease in a Caucasian male, who presented with 4 paralytic episodes before the diagnosis was made. Case ReportA 37-year-old Caucasian man was admitted at the hospital for evaluation of episodic muscular weakness. He recalled four similar episodes in the previous 4 months, which started during sleep or post-exercise rest. Attacks consisted of flaccid muscle weakness that varied from mild proximal leg weakness to quadriparesis, involving mainly the lower-limbs. Three attacks resolved spontaneously over 2 to 8 hours. Hypokalemia (2.3 mEq/L) and mild hypomagnesemia (1.53 mg/dL) were documented in one episode and managed with administration of intravenous potassium chloride in the emergency department. In this attack, proximal flaccid quadriparesis 2/5 was observed, with normal reflexes and sensory examination. The electrocardiogram was normal.Two weeks later (between episodes) laboratory studies revealed normal renal and hepatic function, and the following results: serum sodium 143 mEq/L (136-145), potassium 3.6 mEq/L (3.50-5.10), calcium 9.03 mg/dL (8.27-9.80), albumin 34.5 g/L (34-48), urine sodium 77 mEq/L (25-150), urine potassium 93mEq/L (17-83). He had no significant personal or familial medical history and he was not taking any medication. He related weight loss, distal tremor, and heat Keywords: Hyperthyroidism; Hypokalemia; Thyrotoxic periodic paralysisWe describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thyrotoxic Periodic Paralysis: A Case Report and Literature Review

Barahona¹,

Vinagre²,

Sojo³

et al. 2009

Clinical Medicine & Research

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“…TPP is a very rare complication of AFTN, and only a few cases have been reported to date [24,25]. The reason for such rarity remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…TPP associated with AFTN, however, is very rare as there are only a few case reports [24,25]. Here we report a case with AFTN who suffered from attacks of TPP.…”

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confidence: 82%

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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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