The pitfalls of potassium replacement in thyrotoxic periodic paralysis: a case report and review of the literature
Abstract
Thyrotoxic Periodic Paralysis is an uncommon disorder seen primarily in Asian males and caused by excessive thyroid hormones. This is an endocrine emergency that can lead to respiratory failure, dysrhythmia, and death. The mainstay of therapy has been potassium replacement, however, recent evidence suggests propranolol is a more effective therapy. We present a severe case of TPP in a 22-year-old Latino male with rapidly progressive ascending paralysis and hypokalemia severe enough to lead to cardiac arrest.
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There may be a delayed response of a few hours following potassium administration in TPP.
“There may be a delayed response of a few hours following potassium administration [44].”
From Thyrotoxic Periodic Paralysis: Clinical Challenges (2014) · cites this paper as [44]
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Paz‐Ibarra, J., Sáenz-Bustamante, S., Ildefonso-Najarro, S. P., Portillo-Flores, K., Quispe-Flores, M. A., Dueñas, E. A. P., & Concepción‐Zavaleta, M. J. (2022) · PubMed Central · Cited by 2 · see citing works
Respiratory Failure in Hyperthyroidism: Focus on Thyrotoxic Periodic Paralysis
Tun, T., Htay, W. Y., & Myat, K. (2025) · Cureus · doi:10.7759/cureus.90200 · Cited by 1 · see citing works
Graves' Disease and Periodic Paralysis
Mangaraj, S., Jena, D., Mishra, P. K., Choudhury, A. K., Mohanty, B. K., & Baliarsinha, A. K. (2015) · Journal of the ASEAN Federation of Endocrine Societies · doi:10.15605/jafes.030.02.06 · Cited by 1 · see citing works
A case of type I diabetes mellitus and autoimmune thyroiditis presents with hypokalemic paralysis
Gutch, M., Kumar, S., Razi, S. M., Gupta, A., Gupta, K., & Nath, M. (2015) · Tropical Journal of Medical Research · doi:10.4103/1119-0388.158411 · Cited by 1 · see citing works
Isshak, R., Orhun, N., Rajab, I. M., Shober, D., & Michael, P. (2025) · AACE Endocrinology and Diabetes · doi:10.1016/j.aed.2025.02.005 · Cited by 1 · see citing works
Thyrotoxic Periodic Paralysis – Clinical Diagnosis and Management
Rolim, A. L., & Dias-da-Silva, M. R. (2014) · InTech eBooks · doi:10.5772/58475 · Cited by 1 · see citing works
Family periodic paralysis. Case report and literature review
Rodríguez, J. R. M., Vargas, G. A., Hernández, K. S., Aguilar, R. O., Piña, G. G. A., & Morales‐González, J. A. (2008) · Medicina Interna de México · Cited by 1 · see citing works
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THYROTOXIC PERIODIC PARALYSIS: A CASE REPORT AND REVIEW OF LITERATURE
Choudhuri, R., Adhikari, D., Kar, S. K., & Mitra, S. (2014)
Parálisis hipocaliémica tirotóxica: informe de cuatro casos
Carrillo, L. G. D., & Aguilar, J. G. A. (2006) · Acta Médica Grupo Ángeles
A Diagnostic Challenge: Acute Flaccid Paralysis
Lussier, D., & Herd, A. M. (2016) · Canadian Journal of Emergency Medicine · doi:10.1017/cem.2016.355
Gutch, M., Shakya, S., Bhattacharjee, A., Manjari, D., & Pushkar, D. (2016) · MAMC Journal of Medical Sciences · doi:10.4103/2394-7438.191694
Thyrotoxic periodic paralysis with normokalemia: a rare case report
Kulkarni, P. R., Mohanan, J., Mariraj, I., & Suthakaran, P. K. (2021) · International Journal of Advances in Medicine · doi:10.18203/2349-3933.ijam20212874
Thyrotoxic Periodic Paralysis: A Review and Suggestions for Treatment
Krasnova, S. L., Topilow, A. A., Calissendorff, J., & Falhammar, H. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-76097-3.00006-5
An Unusual Presentation of Thyrotoxicosis: Leg Weakness and Hypokalemia in a 21‐Year‐Old Male
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Moxley, R. T., & Heatwole, C. R. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-0435-8.00089-5
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Thyrotoxic Periodic Paralysis after Surgery: A Case Report and Literature Review
Wouters, C., Willems, M., Mullens, A., & Meersman, A. (2023) · Emergency Medicine - Open Journal · doi:10.17140/emoj-9-172
A case of successful resuscitation from hypokalemic cardiac arrest using rapid intravenous potassium
Kumar, B. L. M., & Rao, P. S. (2026) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2026.02.023
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Management of Electrolyte Disorders
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- Authors
- Tassone, H., Moulin, A., & Henderson, S. O.
- Affiliations
- University of Southern California (US)
- Corresponding author
- Henderson, Sean O
- ORCID
- Moulin, Aimee
- Venue
- The Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2004-02
- Volume
- 26
- Issue
- 2
- Pages
- 157-161
- ISSN
- 0736-4679 (ISSN-L)
- OpenAlex
- W2167214245
- Cited by
- 93
- References
- 40
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 2 · 2022: 7 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 13 · 2013: 3 · 2012: 5
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Emergency Medicine (publishedVersion)
- 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 › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyrotoxic periodic paralysis, potassium supplementation, hypokalemia, propranolol, hyperthyroidism, ascending paralysis, cardiac arrest, endocrine emergencies
- MeSH terms
- Adult, Anti-Arrhythmia Agents, Emergency Medical Services, Humans, Hyperkalemia, Hyperthyroidism, Infusions, Intravenous, Male, Potassium, Propranolol, Thyrotoxicosis, Treatment Outcome, Tachycardia, Ventricular, Hypokalemic Periodic Paralysis
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