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

• Noncompliance

  In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease. [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]

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]

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]