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Thyrotoxic Periodic Paralysis: Correct Hypokalemia with Caution

Lookup NU author(s): Dr Thomas Cope, Professor David Burn


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Background: Thyrotoxic periodic paralysis is rare in Caucasian populations, but affects approximately 2% of East Asians with thyrotoxicosis (13% of males, 0.17% of females). The presentation is characterized by abrupt-onset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise. Objectives: To raise awareness of this condition through the description of a typical case of thyrotoxic periodic paralysis; to remind readers that, despite intravascular hypokalemia, total body potassium is normal and that correction must be done with caution; to highlight the differences in treatment compared to familial hypokalemic periodic paralysis. Case Report: We describe the presentation of a 36-year-old Filipino man with a background history of Graves disease. Over-administration of intravenous potassium was narrowly averted in this case. Conclusion: It may be important to check thyroid function in patients presenting with acute paralysis, especially those of Asian origin. In patients with thyrotoxic periodic paralysis, administration of potassium, with cardiac monitoring and a total dose of <50 mmol, limits the dysrhythmia risk. Patients are likely to benefit from the prescription of non-selective beta-blockers until they become euthyroid. In contrast to familial periodic paralysis, regular oral potassium supplementation is ineffective in thyrotoxic periodic paralysis, and acetazolamide precipitates, rather than prevents, attacks. (C) 2013 Elsevier Inc.

Publication metadata

Author(s): Cope TE, Samaraweera APR, Burn DJ

Publication type: Article

Publication status: Published

Journal: Journal of Emergency Medicine

Year: 2013

Volume: 45

Issue: 3

Pages: 338-340

Print publication date: 09/07/2013

ISSN (print): 0736-4679

ISSN (electronic):

Publisher: Elsevier


DOI: 10.1016/j.jemermed.2012.11.107


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