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Cited by 9Thyroid Disorders and TreatmentsPotassium and Related DisordersCardiac electrophysiology and arrhythmias

Thyrotoxic periodic paralysis associated with lactic metabolic acidosis: Case report of an African man and review of literature

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Allard, Maurine, Barrallier, Mathilde, Pisaroni, Hugo, Fichet, Mathilde, De La Vergne De Cerval, Margot, Pflaum, Robin, Poisson, Audrey, Derrien, Christèle +2 more·2023·Annales d'Endocrinologie
DOI 10.1016/j.ando.2023.01.007
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Abstract

Background Thyrotoxic periodic paralysis (TPP) is a rare and most often acquired subtype of hypokalemic periodic paralysis. The association of varying degrees of muscle weakness, hyperthyroidism and hypokalemia characterizes it. The treatment requires potassium supplementation, control of hyperthyroidism and prevention measures. It is a frequent disease in Asian men, but much rare in Caucasian or African populations. This is the first report of TPP associated with lactic metabolic acidosis in an African man.Case presentation A 23 year-old African man, native from Morocco, with recurrent episodes of tetraparesis for eleven months, and abdominal pain, was referred for evaluation. Biochemical investigations showed severe hypokalemia associated with hyperthyroidism and lactic metabolic acidosis. His EKG showed signs of hypokalemia such as sinus tachycardia and U waves. After potassium supplementation, neurological recuperation was quick and complete. Thyroid ultrasound identified a hypoechogenic and hypervascularized goiter, associated with high levels of thyroid antibodies, in favor of Grave's disease. With antithyroid drugs and life-style changes, the patient did not have any other attack.Review of literature In addition to the case report, this article presents an extended review of literature, from the first large study reporting the diagnosis and incidence of TPP in 1957 to nowadays. Are reported here the latest information concerning epidemiology, clinical manifestations, complementary examinations, management and genetic finding. The lactic acidosis observed initially is exceptional, never described in TPP. TPP is a diagnostic and therapeutic emergency, requiring careful potassium supplementation, in order to avoid the risk of the onset of rebound hyperkalemia, to be maintained until the etiological treatment is effective. Paraclinical assessment with emergency EKG and electromyogram are essential to assess the impact.Discussion It is essential in the face of any hypokalaemic periodic paralysis, including in non-Asian subjects, to search hyperthyroidism.Conclusions This report demonstrates the importance of thyroid testing in case of acute muscle weakness, even in non-Asian patients in order to diagnose TPP. This is a rare but possible etiology, to be distinguished from the familial form of hypokalemic periodic paralysis. It also questions on the impact of TPP on energetic metabolism, in particular on lactic metabolism.

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  • Electrocardiographic changes attributable to hypokalemia-including ST depression, U waves, and QT prolongation-may progress to life-threatening arrhythmias such as ventricular fibrillation.

    “Moreover, electrocardiographic changes attributable to hypokalemia—including ST depression, U waves, and QT prolongation—should prompt urgent intervention, as they may progress to life-threatening arrhythmias such as ventricular fibrillation [9,10].”

    From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [10]

  • In THPP, hypokalemia is primarily attributed to transcellular potassium shifts rather than urinary loss, with urinary potassium excretion often minimal and a urinary potassium/creatinine ratio below 2.5.

    “In THPP, hypokalemia is primarily attributed to transcellular potassium shifts rather than urinary loss; accordingly, urinary potassium excretion is often minimal, with a urinary potassium/creatinine ratio below 2.5 [10].”

    From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [10]

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Authors
Allard, M., Barrallier, M., Pisaroni, H., Fichet, M., De La Vergne De Cerval, M., Pflaum, R., Poisson, A., Derrien, C., Bonnet, F., & Vaduva, P.
Affiliations
Centre Hospitalier Universitaire de Rennes (FR)
Corresponding author
Allard, Maurine
ORCID
Venue
Annales d'Endocrinologie
Publisher
Elsevier BV
Published
2023-08
Volume
84
Issue
4
Pages
440-445
ISSN
0003-4266 (ISSN-L)
DOI
10.1016/j.ando.2023.01.007
OpenAlex
W4319460046
Cited by
9
References
35
Citations by year
2026: 1 · 2025: 4 · 2024: 3 · 2023: 1
FWCI
1.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Annales d Endocrinologie (acceptedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
thyrotoxic periodic paralysis, hypokalemia, hyperthyroidism, Graves' disease, tetraparesis, potassium supplementation, hypokalemic periodic paralysis, lactate metabolism, African patients
MeSH terms
Acidosis, Lactic, Adult, Humans, Hyperthyroidism, Hypokalemia, Male, Paralysis, Potassium, Thyrotoxicosis, Muscle Weakness, Hypokalemic Periodic Paralysis, Young Adult

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