Factors like highcarbohydrate meal exercise, steroid, and stress can. Hypokalaemia was identified and treated with resolution of symptoms. Pdf thyrotoxic hypokalemic periodic paralysis tpp is a condition. Periodicparalysis differential diagnosis and important. Thyrotoxic periodic paralysis is a rare endocrine disorder seen predominantly in men of asian origin. Thyrotoxic periodic paralysis clinical diagnosis and management. As the total body stores of potassium remain normal, overzealous potassium supplementation targeting serum potassium level results in a poor outcome. Not everyone who develops high thyroid hormone levels will be at risk of periodic paralysis. Thyrotoxic periodic paralysis complicated by acute.
It is treated by infusion or oral supplementation with potassium and with resolution of the thyrotoxicosis state. Thyrotoxic periodic paralysis in the chinese population. The presentation is characterized by abruptonset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise. A total of 281 primary articles and 168 references of. Episodes typically involve a temporary inability to move muscles in the arms and legs. The condition is associated with massive intracellular shift of potassium, mainly in skeletal muscles. Chang cc, cheng cj, sung cc, chiueh ts, lee ch, chau t, et al. Thyrotoxic periodic paralysis archives of physical medicine.
Hypokalaemic paralysis results from either alteration in transcellular distribution of potassium or actual potassium depletion from renal or extrarenal losses. It occurs in people who have high levels of thyroid hormone in their blood hyperthyroidism, thyrotoxicosis. It is most prevalent in young asian and latin american men, and much rarer in. Muscle weakness in patients with thyrotoxicosis during hypokalemic episodes thyrotoxic periodic paralysis tpp occurs sporadically and mostly in males. Thyrotoxic periodic paralysis hyperaldosteronism rta villous adenoma cocaine binge diuretics, licorice, steroids, etoh hyperkalemic k5. Thyrotoxic periodic paralysis is a condition in which there are episodes of severe muscle weakness. Click on the link to view a sample search on this topic. Trifanescu ra, danciulescu mr, carsote m, poiana c. If you continue browsing the site, you agree to the use of cookies on this website. Hypokalemia, with associated flaccid paralysis, and signs of hyperthyroidism, are the hallmark. The patient presented with sudden onset paralysis of his extremities. It is most prevalent in young asian and latin american men, and much rarer in caucasians and africans. Hypokalemiarelated medical emergencies vary from muscle weakness to paralysis and are called hypokalemic paralysis. Hypokalemic periodic paralysis hypokpp, also known as familial hypokalemic periodic paralysis fhpp, is a rare, autosomal dominant channelopathy characterized by muscle weakness or paralysis when there is a fall in potassium levels in the blood.
Thyrotoxic periodic paralysis tpp is a medical emergency characterized by an acute and reversible attack of. If you have problems viewing pdf files, download the latest version of adobe reader. Among the hypopp, familial hypokalemic periodic paralysis fpp is the most common cause in western countries, and thyrotoxic periodic paralysis tpp. There is a similar disorder, called hypokalemic, or familial, periodic paralysis. Periodic paralysis pp is a rare neuromuscular disorder related to a defect in muscle ion channels, characterized by episodes of painless muscle weakness, which may be precipitated by heavy exercise, fasting, or highcarbohydrate meals. Familial periodic paralysis is a rare autosomal dominant condition with considerable variation in penetrance characterized by episodes of flaccid paralysis with loss of deep tendon reflexes and failure of muscle to respond to electrical stimulation. Case report open access surgical treatment for thyrotoxic. Thyrotoxicosis can present as a sporadic form of hypokalaemic periodic. The patients paralysis resolved upon repletion of his low potassium and he was.
Hypokalemic periodic paralysis genetic and rare diseases. We present a fatal case of thyrotoxic hypokalaemic periodic paralysis. They frequently think of hypokalemic periodic paralysis and check the potas sium level in cases of peripheral weakness. Patients with thyrotoxic hypokalemic periodic paralysis typically present at the er with an acute episode of paralysis involving the muscles of the extremities and limb girdles. Pubmed is a searchable database of medical literature and lists journal articles that discuss thyrotoxic periodic paralysis. Hypokalaemic paralysis postgraduate medical journal. A 10year analysis of thyrotoxic periodic paralysis in5 patients. Thyrotoxic periodic paralysis tpp is a rare disease entity that is often overlooked. Hypokalemia a decreased potassium level in the blood is usually present during attacks. Further investigations revealed a low thyroidstimulating hormone and high free thyroxine levels.
Thyrotoxic hypokalemic periodic paralysis thypokpp is an uncommon disorder with an unknown etiology. A 39yearold white man was admitted to our hospital for progressive weakness of several. Laboratory evaluation revealed a markedly low potassium level. Most cases are due to a transcellular shift of potassium and the differential diagnosis includes familial periodic paralysis, thyrotoxic periodic paralysis, and barium poisoning. Thyrotoxic periodic paralysis definition of thyrotoxic. Hyperthyroidism can unmask thyrotoxic periodic paralysis tsh will be low free t4 or total t3 will be elevated. We report the very rare complications of involvement of the respiratory muscles and ventricular tachycardia in this disorder.
It is important for physicians to distinguish tpp from familial hypokalemic periodic paralysis, a more common. The patient was started on potassium supplementation and he recovered his muscle strength. Thyrotoxic hypokalemic periodic paralysis in combination with an acute episode of general flaccid paralysis and hypokalemia is common in young asian men with hyperthyroidism. Hypokalemic periodic paralysis hokpp is characterized by episodes of muscle paralysis associated with a fall in blood potassium levels hypokalemia. Thyrotoxic hypokalemic periodic paralysis journal of. Susceptible individuals often have an underlying channelopathy, which may be exacerbated by lifestyle factors or underlying medical comorbidities such as hyperthyroidism or. A medline search was conducted for articles published during the last 40 yr based on the key words thyrotoxic periodic paralysis and hypokalemic periodic paralysis. Thyrotoxic periodic paralysis is a sporadic entity characterized by hypokalemia and paralysis in the setting of hyperthyroidism. The most common causes are thyrotoxic hypokalemic periodic paralysis tpp and familial hypokalemic periodic paralysis fpp. Because of the clinical characteristics of the condition, its triggers, the finding of hypokalemia, the absence of a family history of periodic paralysis, and symptom. The condition may be lifethreatening if weakness of the breathing muscles leads to respiratory failure, or if the low potassium levels lead to. Proximal strength is more severely impaired than distal strength. This test was previously described in 1992 by kantola and tarssanen in neurology in patients with familial hypokalemic periodic paralysis fhopp. Pdf on jun 17, 2016, adam zayac and others published thyrotoxic hypokalemic periodic paralysis find, read and cite all the research you.
Hypokalemic periodic paralysis, familial rare, usually sodium. Pdf download thyrotoxic periodic paralysis clinical. Propranolol rapidly reverses paralysis, hypokalemia, and. Thyrotoxic hypokalemic periodic paralysis in a turkish. The disease is an easily treatable entity but, if missed, can be. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal complication of hyperthyroidism characterised by muscle paralysis and hypokalaemia. It is vital for physicians to be able to differentiate tpp from familial hypokalemic periodic paralysis. Hypokalemic periodic paralysis is one form of periodic paralysis, a rare group of disorders that can cause of sudden onset weakness. A 10year analysis of thyrotoxic periodic paralysis in 5 patients. Absence of ion channels cacn1as and scn4a mutations in. A rare case of hypokalemic ventricular tachycardia in a. Thyrotoxic periodic paralysis tpp is a wellknown complication of hyperthyroidism, characterised by recurrent flaccid paralysis with hypokalaemia. Hyperthyroidism myalgia rapidly progressing paralysis.
The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Potassium and phosphate supplements have been recommended to hasten recovery and prevent cardiopulmonary complications. Thyrotoxic periodic paralysis british journal of medical. The primary cause of thyrotoxic periodic paralysis is unknown. Emergency treatment of thyrotoxic hypokalemic periodic. We recently observed a patient with thyrotoxic periodic paralysis who had myopathic changes compatible with thyrotoxicosis in addition. We briefly report our results using the potassium exercise test in a patient with thyrotoxic periodic paralysis tpp. Thyrotoxic hypokalemic periodic paralysis thpp is a condition that results in transient skeletal muscle paralysis secondary to intracellular potassium sequestration. Thyrotoxic periodic paralysis tpp, a disorder most commonly seen in asian men, is characterized by abrupt onset of hypokalemia and paralysis.
A mutation in the kcne3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis. Printable pdf version download here dec 2017 this article focuses on questions that arise about diagnosis and treatment for people with hypokalemic periodic paralysis. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis tpp. Hyperthyroid periodic paralysis hpp is a rare but potentially lethal manifestation of hyperthyroidism, which mainly affect young asian males in the age group of 2040 years although hyperthyroidism is more commonly in females. Pdf thyrotoxic hypokalemic periodic paralysis researchgate. Thyrotoxic hypokalemic periodic paralysis thpp is a very rare complication of thyrotoxicosis in whites, but is more frequently reported in individuals of asian descent. Risk factors include a family history of periodic paralysis and. A 29yearold man exhibited profound paralysis after. The case is reported of a patient who presented to the accident and emergency department with sudden onset of weakness of his lower limbs. It is often not recognised when first seen because of lack of familiarity with the disorder and partly due to the subtleness of thyrotoxicosis.
Additional tests identified the patient as being thyrotoxic. Thyrotoxic periodic paralysis genetic and rare diseases. Thyrotoxic periodic paralysis information mount sinai. Thyrotoxic periodic paralysis tpp is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism overactivity of the thyroid gland. The lower limbs are more frequently and severely involved than the upper. Periodic paralysis comprises a group of neuromuscular diseases in which the patients present with paroxysmal muscle weakness of the limbs. Thyrotoxic periodic paralysis is rare in caucasian populations, but affects approximately 2% of east asians with thyrotoxicosis % of males, 0. Thyrotoxic periodic paralysis tpp is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. Patrick, thyrotoxic periodic paralysis in the united states report of 7 cases and revie of the literature. Thyrotoxic periodic paralysis clinical diagnosis and. Case report open access surgical treatment for thyrotoxic hypokalemic periodic paralysis. Hypokalemia and hypophosphatemia are commonly encountered during paralysis in patients with thyrotoxic periodic paralysis tpp and may contribute to neuromuscular manifestations. Pp is classified as hypokalemic when episodes occur in association with low potassium blood levels or as.
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