Design/Methods: A 34-year old Asian male of Chinese descent presented with acute onset ascending paralysis. The night prior to the presentation, the patient went to sleep with leg tightness and when he woke up he was quadriplegic. [neurology.org]

Extreme cases with severe hypokalemia may present with respiratory muscle weakness requiring ventilator support or fatal arrhythmias. [mamcjms.in]

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

• Cyanosis

  On general physical examination, there was no pallor, icterus, cyanosis, clubbing, lymphadenopathy or pedal oedema. Multinodular goitre was noted on thyroid examination. [bjmp.org]

• Fear

  Stress/excitement/fear/epinephrine. In ~12%. Stress, excitement, or fear results in the body producing epinephrine, which makes episodes of paralysis more likely in some individuals. [ncbi.nlm.nih.gov]

• 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]

  There was no evidence of tremors, goiter, or any eye and nail-bed changes. [mamcjms.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]

  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]

• Limb Weakness

  Thyrotoxic periodic paralysis classically presents with proximal lower limb weakness in the setting of hypokalemia and thyrotoxicosis. [ncbi.nlm.nih.gov]

  Subsequently, his weakness improved and serum potassium normalized. The patient is regularly followed up, and compliance to therapy is ensured. There were no further episodes of limb weakness since the initiation of antithyroid medications. [mamcjms.in]

  TPP classically presents with proximal lower-limb weakness in the setting of a low potassium level and biochemical evidence of thyrotoxicosis: low thyroid-stimulating hormone levels along with elevated free thyroxine (FT 4 ) or free triiodothyronine [cambridge.org]

  Case History A 30-year-old male patient, who was an agriculturist by profession, presented with weakness of all four limbs of one-day duration. The weakness first appeared in his lower limbs and then in the upper limbs. [bjmp.org]

• 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]

Therefore thyroid function tests are part of the diagnostic workup of hypokalemic periodic paralysis. Correction of thyroid function is essential to treatment. The pathophysiology is still controversial. [ncbi.nlm.nih.gov]

• Hyperinsulinemia

  Abstract The pathogenesis of thyrotoxic periodic paralysis has long been thought related to increased Na(+)-K(+) ATPase activity stimulated by thyroid hormone and/or hyperadrenergic activity and hyperinsulinemia. [ncbi.nlm.nih.gov]

  ATPase pump and result in cellular uptake of potassium. [13], [14], [15] Thyroid hormones may also directly stimulate Na + /K + -ATPase activity and increase the number and sensitivity of beta-receptors. [13], [16] Patients with TPP have associated hyperinsulinemia [mamcjms.in]

  […] that observed in THPP. 1 Hypokalemia may be exacerbated by catecholamine-induced potassium shifts. 1,4,6 This is from the increased β 2 -adrenergic stimulation from the concurrent hyperadrenergic state caused by the underlying hyperthyroidism. 1,4,6 Hyperinsulinemia [mdedge.com]

  Hyperinsulinemia in thyrotoxic hypokalemic periodic paralysis. Lancet. 1991;337(∭):1063-4. [ Links ] 10. Lin S-H. Thyrotoxic periodic paralysis. Mayo Clin Proc. 2005;80(1):99-105. [ Links ] 11. [scielo.org.mx]

• 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]

He had suffered from similar episodes of weakness thrice in the past, for which he was hospitalized and recovered completely following treatment. [mamcjms.in]

The exercise test is a useful electrophysiologic means of monitoring the neuromuscular status of patients with thyrotoxic periodic paralysis prior to, and after treatment of the thyrotoxicosis. [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 report discusses the epidemiology, presentation, treatment, and complications of this condition. [ncbi.nlm.nih.gov]

Home, Search, Index, Links, Pathology, Molecules, Syndromes, Muscle, NMJ, Nerve, Spinal, Ataxia, Antibody & Biopsy, Patient Info EPISODIC MUSCLE WEAKNESS Hypokalemic Periodic Paralysis Hypokalemic periodic paralysis, Hereditary: General features Epidemiology [neuromuscular.wustl.edu]

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]

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

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]

Immediate potassium supplementation prevents serious cardiopulmonary complications and may hasten the recovery of muscle weakness. Nonselective β-adrenergic blockers can ameliorate and prevent recurrence of the paralytic attacks. [dx.doi.org]