Cited by 30Thyroid Disorders and TreatmentsPotassium and Related DisordersMuscle and Compartmental Disorders

Diagnosing thyrotoxic periodic paralysis in the ED

Lin, Yuh-Feng, Wu, Chia-Chao, Pei, Dee, Chu, Shi-Jye, Lin, Shih-Hua·2003·The American Journal of Emergency Medicine

Abstract

Thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (SPP) are the most common causes of hypokalemic periodic paralysis (HPP) in EDs in Asia. Their neuromuscular presentations are almost indistinguishable. We conducted this study to identify clinical clues that can help EPs distinguish between TPP and SPP. Thirty-four patients presenting to the ED with HPP were enrolled during a 3-year period. They did not have known hyperthyroidism before the attack and no family history of paralysis. They all had low K(+) excretion rates. Vital signs and blood biochemistry, including acid-base and electrolytes, were measured. TPP was subsequently established by thyroid function tests. Twenty patients had TPP and 14 patients had SPP. There was no significant difference in age and sex distribution between them. Systolic (SBP) but not diastolic blood pressure (SBP 145 +/- 4 vs 128 +/- 4 mm Hg, P < 0.001) and heart rate (106 +/- 3 vs 73 +/- 3 beats/min, P < 0.001) were significantly higher in those experiencing TPP than SPP. Among the biochemical factors, only plasma phosphate concentration (2.2 +/- 0.2 vs 3.2 +/- 0.2 mg/dL, P < 0.001) was significantly lower in those experiencing TPP than SPP. Systolic hypertension, tachycardia, and hypophosphatemia are clinical clues favoring the diagnosis of TPP.

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Crossref · 10.1016/s0735-6757(03)00037-8

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Authors
Lin, Y.-F., Wu, C.-C., Pei, D., Chu, S.-J., & Lin, S.-H.
Affiliations
Tri-Service General Hospital (TW)
Corresponding author
Lin, Shih-Hua
Venue
The American Journal of Emergency Medicine
Publisher
Elsevier BV
Published
2003-07
Volume
21
Issue
4
Pages
339-342
ISSN
0735-6757 (ISSN-L)
OpenAlex
W2055116853
Cited by
30
References
36
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2021: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2015: 1 · 2014: 3 · 2013: 3 · 2012: 2
FWCI
1.22
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Tri-Service General Hospital
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 › Muscle and Compartmental Disorders
Keywords
thyrotoxic periodic paralysis, hypokalemic periodic paralysis, differential diagnosis, hypophosphatemia, systolic hypertension, tachycardia, plasma phosphate, hyperthyroidism, emergency department
MeSH terms
Adult, Diagnosis, Differential, Humans, Hypophosphatemia, Familial, Middle Aged, Thyrotoxicosis, Hypokalemic Periodic Paralysis

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