The case history and update of current knowledge of thyrotoxic periodic paralysis is presented. [ncbi.nlm.nih.gov]

• Vietnamese

  A 23-year-old Vietnamese male presented with a 2-h history of complete flaccid quadriplegia and chest tightness. Electrolyte studies revealed a critical potassium level of 1.4 mmol/L. [ncbi.nlm.nih.gov]

  It occurs predominantly in males of Chinese, Japanese, Vietnamese, Filipino, and Korean descent. TPP is one of several conditions that can cause periodic paralysis. An attack often begins with muscle pain, cramping, and stiffness. [en.wikipedia.org]

  […] disorder with three characteristics which occur at the same time: too much thyroid hormone low levels of potassium in the blood (hypokalemia) muscle weakness or paralysis TPP occurs most often in males of Asian descent, including Japanese, Chinese, Vietnamese [hkpp.org]

  It is most commonly seen in Asian men (Chinese, Vietnamese, Filipino and Koreans). In North America the incidence is 0.1% to 0.2%. [omicsonline.org]

• Thyroid Bruit

  Multinodular goitre was noted on thyroid examination. There was no exopthalmos, lid lag, pretibial myxoedema or other signs of thyrotoxicosis. Thyroid bruit was absent. [bjmp.org]

• Suggestibility

  Given that there is much racial variation in the prevalence of TPP, and the suggestion that non-thyrotoxic periodic paralysis may be more prevalent in Maori, the case highlights the need for more research into the prevalence and pathogenesis of TPP in [ncbi.nlm.nih.gov]

• Impulsivity

  Hypokalemia leads to hyperpolarization of muscle cells, making the neuromuscular junction less responsive to normal nerve impulses and leading to decreased contractility of the muscles.It is not clear how the described genetic defects increase the Na+ [en.wikipedia.org]

  Low potassium levels in the serum lead to hyperpolarization of skeletal muscle cells, making the neuromuscular junction less responsive to normal nerve impulses, which in turn decreases the contractility of the muscles [7]. [cureus.com]

  Cardiovascular examination during this time showed apical impulse at left 6 th intercostal space 0.5 cm lateral to the mid-clavicular line with forceful ill-sustained character. [jnsbm.org]

• Tremor

  Or, there may be signs of hyperthyroidism, such as an enlarged thyroid changes in the eyes, tremor, hair and nail changes. [nlm.nih.gov]

  Case 3 A 32-year-old male presented with acute onset flaccid paraparesis, tremors of both hands and palpitations. He had a history of transient proximal weakness 6 weeks back which recovered spontaneously. [ijem.in]

  TPP may be associated with the following cardinal features of hyperthyroidism: systolic hypertension with a wide pulse pressure, tachycardia, tremor, and weight loss. [blogs.nejm.org]

  They include: Weight loss Palpitations Heat intolerance Increased appetite Agitation Insomnia Hand tremors A fast heart rate Excessive sweating The attack itself normally begins with muscle pain, cramps or muscle stiffness followed by weakness which begins [markvanderpump.co.uk]

• Flaccid Paralysis of the Lower Extremity

  We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. [ncbi.nlm.nih.gov]

• Fine Tremor

  He had tachycardia, fine tremors of both hands, and grade1 diffuse goiter. His serum potassium was 1.8 mmol/l, ESR 30 mm/h, TSH 0.03 μU/l, free T4:3.2 ng/dl, TPO antibody 117 IU/ml (nl < 35), and there was decreased uptake (0.21%) on 99m Tc scan. [ijem.in]

• Cerebellar Sign

  Upon initial assessment the patient had a mild tachycardia but with otherwise normal vital signs. Neurological assessment demonstrated intact cranial nerves, absence of cerebellar signs, and preserved upper extremity motor and sensory exams. [westjem.com]

• Dysautonomia

  Asian White Any Any Family history of paralysis No Yes No No Precipitating factors Heavy carbohydrate and/or salt meal, alcohol, exercise, stress Heavy carbohydrate and/or salt meal, alcohol, exercise, dehydration Usually preceded by an infection No Dysautonomia [intechopen.com]

The patient was admitted to the intensive care unit where further workup revealed thyrotoxicosis and the patient was subsequently diagnosed with TPP. [ncbi.nlm.nih.gov]

• Potassium Decreased

  Studies suggest that restoration of potassium levels leads to resolution of paralysis, with potassium decreasing the time to resolution from 13 hours to six hours. 5 However, the physiology of TTP suggests that patients are not truly deficient in potassium [westjem.com]

• Testosterone Increased

  […] the Na/K ATPase activity. 9 There is an increase in the β adrenergic receptors in skeletal muscles, which increase the Na/K ATPase activity. 7 These factors along with insulin and testosterone increase the intracellular shift of potassium. [emj.bmj.com]

• Non Specific ST-T Changes

  EKG findings were significant for atrial premature complexes and non-specific ST-T changes. [cureus.com]

• Right Bundle Branch Block

  Our patient was found to have an extremely low serum potassium concentration, as well as an electrocardiogram that revealed a prolonged QT interval and right bundle branch block. [ncbi.nlm.nih.gov]

• Ventricular Hypertrophy

  Electrocardiogram was significant for sinus tachycardia and left ventricular hypertrophy. [westjem.com]

Treatment includes the supplementation of potassium, a nonselective beta-blocker, and ultimately treatment of the underlying hyperthyroidism. [ncbi.nlm.nih.gov]

The pathophysiology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed. [ncbi.nlm.nih.gov]

Family history Timing Intensity History of administration of certain drugs Clinical examination Differential Diagnosis Laboratory investigations Serum K+ CPK and serum myoglobin ECG EMG Nerve conduction studies Provocative Testing Muscle biopsy Treatment Prognosis [slideshare.net]

Severe prognosis in a large family with hypokalemic periodic paralysis. Muscle Nerve 27, 165–169 (2003). 88. Okihiro, M. M. & Nordyke, R. A. Hypokalemic periodic paralysis. Experimental precipitation with sodium liothyronine. [nature.com]

The etiology of these abnormalities and the patient's symptoms was found to be undiagnosed and uncontrolled hyperthyroidism from Grave's disease, which resulted in this dramatic presentation of thyrotoxic hypokalemic paralysis. [ncbi.nlm.nih.gov]

The epidemiology, aetiology and pathogenesis of TPP are discussed. The case demonstrates that neurological examination and biochemical findings may be normal between episodes of paralysis. [ncbi.nlm.nih.gov]

(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies) Pathophysiology Epidemiology Primary or familial periodic paralysis Secondary periodic paralysis Conventional classification [slideshare.net]

Here we report three cases of TPP in the Netherlands, and review the literature on clinical features, pathophysiological hypothesis and treatment. [ncbi.nlm.nih.gov]

Immediate potassium supplementation prevents serious cardiopulmonary complications and may hasten the recovery of muscle weakness. Nonselective beta-adrenergic blockers can ameliorate and prevent recurrence of the paralytic attacks. [ncbi.nlm.nih.gov]

Treating hyperthyroidism will prevent attacks and may even reverse muscle weakness. [nlm.nih.gov]

The maintenance of a euthyroid status is an essential part of management as this prevents the paralytic episodes. [actamedicaportuguesa.com]

These episodes can be prevented by treating the patient’s thyroid disease hence preventing hyperthyroid states and with the use of propranolol to reduce the beta-adrenergic activity. [hsrc.himmelfarb.gwu.edu]