Diagnosing thyrotoxic periodic paralysis in the ED
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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Periodic paralysis complicating thyrotoxicosis in Chinese.
McFadzean, A. J., & Yeung, R. (1967) · BMJ · doi:10.1136/bmj.1.5538.451 · Cited by 303 · see citing works
Thyrotoxic Periodic Paralysis in the United States Report of 7 Cases and Review of the Literature
OBER, K. P. (1992) · Medicine · doi:10.1097/00005792-199205000-00001 · Cited by 289 · see citing works
Clinical and Metabolic Features of Thyrotoxic Periodic Paralysis in 24 Episodes
Manoukian, M. A., Foote, J. A., & Crapo, L. M. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.6.601 · Cited by 255 · see citing works
METABOLIC AND RENAL STUDIES IN CHRONIC POTASSIUM DEPLETION RESULTING FROM OVERUSE OF LAXATIVES 12
Schwartz, W. B., & Relman, A. S. (1953) · Journal of Clinical Investigation · doi:10.1172/jci102735 · Cited by 254 · see citing works
Internal Potassium Balance and the Control of the Plasma Potassium Concentration
Sterns, R. H., Cox, M., Feig, P. U., & Singer, I. I. (1981) · Medicine · doi:10.1097/00005792-198109000-00002 · Cited by 244 · see citing works
Sternberg, D. (2001) · Brain · doi:10.1093/brain/124.6.1091 · Cited by 214 · see citing works
Catecholamine-thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism
Levey, G. S., & Klein, I. L. (1990) · The American Journal of Medicine · doi:10.1016/0002-9343(90)90533-j · Cited by 212 · see citing works
Impact of Hyperthyroidism and Its Correction on Vascular Reactivity in Humans
Napoli, R., Biondi, B., Guardasole, V., Matarazzo, M., Pardo, F., Angelini, V., Fazio, S., & Saccà, L. (2001) · Circulation · doi:10.1161/hc5001.100621 · Cited by 187 · see citing works
Hypokalemic paralyses: A review of the etiologies, pathophysiology, presentation, and therapy
Stedwell, R. E., Allen, K., & Binder, L. S. (1992) · The American Journal of Emergency Medicine · doi:10.1016/0735-6757(92)90048-3 · Cited by 186 · see citing works
Lin, S.-H. (2001) · QJM · doi:10.1093/qjmed/94.3.133 · Cited by 173 · see citing works
Self-citationIn vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis.
Chan, A., Shinde, R., Chow, C. C., Cockram, C. S., & Swaminathan, R. (1991) · BMJ · doi:10.1136/bmj.303.6810.1096 · Cited by 160 · see citing works
Thyrotoxic periodic paralysis in a Chinese population
Ko, G. T. C., Chow, C. C., Yeung, V. T. F., Chan, H. H. L., LI, J. K. Y., & Cockram, C. S. (1996) · QJM · doi:10.1093/qjmed/89.6.463 · Cited by 160 · see citing works
Lin, S.-H., & Lin, Y.-F. (2001) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2001.22090 · Cited by 148 · see citing works
Self-citationAhlawat, S. K., & Sachdev, A. (1999) · Postgraduate Medical Journal · doi:10.1136/pgmj.75.882.193 · Cited by 141 · see citing works
Acetazolamide Treatment of Hypokalemic Periodic Paralysis
Griggs, R. C., ENGEL, W. K., & RESNICK, J. S. (1970) · Annals of Internal Medicine · doi:10.7326/0003-4819-73-1-39 · Cited by 133 · see citing works
Yeung, R. T. T., & Tse, T. F. (1974) · The American Journal of Medicine · doi:10.1016/0002-9343(74)90010-2 · Cited by 115 · see citing works
Theophylline Toxicity and the Beta-Adrenergic System
Kearney, T. E., MANOGUERRA, A. S., CURTIS, G. P., & ZIEGLER, M. G. (1985) · Annals of Internal Medicine · doi:10.7326/0003-4819-102-6-766 · Cited by 99 · see citing works
Body, J., Cryer, P. E., Offord, K. P., & Heath, H. (1983) · Journal of Clinical Investigation · doi:10.1172/jci110802 · Cited by 89 · see citing works
Kunin, A. S., Surawicz, B., & Sims, E. A. H. (1962) · New England Journal of Medicine · doi:10.1056/nejm196202012660504 · Cited by 89 · see citing works
Etiology and Prevention of Substance Use Among Asian American Youth
Harachi, T. W., Catalano, R. F., Kim, S., & Choi, Y. (2001) · Prevention Science · doi:10.1023/a:1010039012978 · Cited by 79 · see citing works
Plasma renin activity in syndromes of thyroid hormone excess and deficiency
Resnick, L. M., & Laragh, J. H. (1982) · Life Sciences · doi:10.1016/0024-3205(82)90273-9 · Cited by 76 · see citing works
Thyrotoxic Periodic Paralysis Terminated With Intravenous Propranolol
Shayne, P. H., & Hart, A. (1994) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(94)70286-1 · Cited by 73 · see citing works
Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting
Birkhahn, R., Gaeta, T. J., & Melniker, L. A. (2000) · Journal of Emergency Medicine · doi:10.1016/s0736-4679(99)00194-8 · Cited by 66 · see citing works
Yang, F., Teng, W., Shan, Z., Guan, H., Li, Y., Yu, J. M., Hu, F., Shi, X., Tong, Y., Chen, W., et al. (2002) · European Journal of Endocrinology · doi:10.1530/eje.0.1460613 · Cited by 64 · see citing works
Emile, J. (1968) · PubMed · Cited by 59 · see citing works
Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences
Braden, G. L., von Oeyen, P. T., Germain, M. J., Watson, D. J., & Haag, B. L. (1997) · Kidney International · doi:10.1038/ki.1997.255 · Cited by 55 · see citing works
Goh, S. H. (2002) · Emergency Medicine Journal · doi:10.1136/emj.19.1.78 · Cited by 32 · see citing works
Thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia
Norris, K. C., Levine, B. S., & Ganesan, K. (1996) · American Journal of Kidney Diseases · doi:10.1016/s0272-6386(96)90312-1 · Cited by 32 · see citing works
Decreased Serum Phosphate in Essential Hypertension: Related to Increased Sympathetic Tone
Kjeldsen, S., Os, I., Westheim, A. S., FREDERICHSEN, P., Hjermann, I., Eide, I. K., & Gautvik, K. M. (1988) · American Journal of Hypertension · doi:10.1093/ajh/1.4.403 · Cited by 28 · see citing works
Hypokalemic, Hypophosphatemic Thyrotoxic Periodic Paralysis
Nora, N. A., & Berns, A. S. (1989) · American Journal of Kidney Diseases · doi:10.1016/s0272-6386(89)80060-5 · Cited by 26 · see citing works
Hypophosphatemia in Thyrotoxic Periodic Paralysis
Guthrie, G. P. (1978) · Archives of Internal Medicine · doi:10.1001/archinte.1978.03630330082026 · Cited by 23 · see citing works
Thyrotoxic hypokalemic periodic paralysis reversed by propranolol without rebound hyperkalemia
Huang, T.-Y., & Lin, S. (2001) · Annals of Emergency Medicine · doi:10.1067/mem.2001.113951 · Cited by 21 · see citing works
Self-citationCHEN, K.-M. (1965) · Archives of Neurology · doi:10.1001/archneur.1965.00460260055007 · Cited by 20 · see citing works
Kim, S., Kim, U. K., Chae, J. J., Kim, D. J., Oh, H., Kim, B. J., & Lee, C. C. (2001) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/16.5.939 · Cited by 17 · see citing works
TREATMENT OF FAMILIAL PERIODIC HYPOKALAEMIA WITH PROPRANOLOL (INDERAL ®)
Johnsen, T. (2009) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1977.tb01467.x · Cited by 11 · see citing works
Coronary disease prevention. Proof of the anticholesterol pudding.
Podell, R. (1984) · Postgraduate medicine · doi:10.1080/00325481.1984.11716319 · Cited by 11 · see citing works
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Sorted by citations
Lin, S.-H. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.1.99 · Cited by 254 · see citing works
Self-citationEffects of potassium supplementation on the recovery of thyrotoxic periodic paralysis
Lu, K.-C., Hsu, Y.-J., Chiu, J.-S., Hsu, Y.-D., & Lin, S.-H. (2004) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2004.09.016 · Cited by 134 · see citing works
Self-citationChang, C.-C., Cheng, C.-J., Sung, C.-C., Chiueh, T.-S., Lee, C.-H., Chau, T., & Lin, S.-H. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0381 · Cited by 114 · see citing works
Self-citationThyroid disease in the emergency department: A clinical and laboratory review
Pimentel, L., & Hansen, K. N. (2005) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2004.08.020 · Cited by 87 · see citing works
Thyrotoxic periodic paralysis: clinical and molecular aspects
Falhammar, H., Thorén, M., & Calissendorff, J. (2012) · Endocrine · doi:10.1007/s12020-012-9777-x · Cited by 74 · see citing works
Lam, L., Nair, R. J., & Tingle, L. (2006) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2006.11928143 · Cited by 76 · see citing works
Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years
Shiang, J.-C., Cheng, C.-J., Tsai, M.-K., Hung, Y.-J., Hsu, Y.-J., Yang, S.-S., Chu, S.-J., & Lin, S.-H. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0553 · Cited by 56 · see citing works
Self-citationIs There a Relationship between Hyperkalemia and Propofol?
Lee, J., Ko, Y.-S., Shin, H.-J., Yi, J.-H., Han, S.-W., & Kim, H. J. (2011) · Electrolytes & Blood Pressure · doi:10.5049/ebp.2011.9.1.27 · Cited by 22 · see citing works
Thyrotoxic periodic paralysis and anesthesia report of a case and literature review
Diedrich, D. A., & Wedel, D. J. (2006) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2005.08.016 · Cited by 14 · see citing works
Vanderpump, M. P. J. (2018) · Wiley eBooks · doi:10.1002/9781119374800.ch18 · Cited by 9 · see citing works
Case of Thyrotoxic Periodic Paralysis in a Caucasian Male and Review of Literature
Thethi, T. K., Parks, R., Katalenich, B., Chhabra, P. T., McCaw, J. M., Syu, S., Nguyen, T., Larrazolo, J., Munshi, K., Waddadar, J., et al. (2014) · Case Reports in Medicine · doi:10.1155/2014/314262 · Cited by 8 · see citing works
A single-center retrospective study on the clinical features of thyrotoxic periodic paralysis
Yamada, K., Tanabe, A., Hashimoto, M., Ohsugi, M., Ueki, K., & Kajio, H. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308076 · Cited by 7 · see citing works
Novel lincRNA Susceptibility Gene and Its Role in Etiopathogenesis of Thyrotoxic Periodic Paralysis
Melo, M. C. C., de Souza, J. S., Kizys, M. M. L., Vidi, A. C., Dorta, H. S., Kunii, I. S., Giannocco, G., Carvalheira, G. M. G., & Dias-da-Silva, M. R. (2017) · Journal of the Endocrine Society · doi:10.1210/js.2017-00015 · Cited by 6 · see citing works
The insulin-sensitivity sulphonylurea receptor variant is associated with thyrotoxic paralysis
Rolim, A. L., Lindsey, S. C., Kunii, I. S., Crispim, F., Moisés, R. S., Maciel, R. M. B., & Dias-da-Silva, M. R. (2014) · Journal of Molecular Endocrinology · doi:10.1530/jme-14-0083 · Cited by 5 · see citing works
Parálisis periódica hipopotasémica tirotóxica: Caso clínico
Frantchez, V., VALIÑO, J., CARRACELAS, A., & Dufrechou, C. (2010) · Revista médica de Chile · doi:10.4067/s0034-98872010001200013 · Cited by 5 · see citing works
Parálisis períodica hipocalcémica tirotóxica
Pinzón, A., & Vásquez, N. (2014) · Revista Med · doi:10.18359/rmed.1032 · Cited by 10 · see citing works
Parálisis periódica tirotóxica
Duarte, J. L., & Sanabria, Á. (2019) · Acta Médica Colombiana · doi:10.36104/amc.2011.1470 · Cited by 4 · see citing works
Periodic Paralysis and Encephalopathy as Initial Manifestations of Graves’ Disease
Tsironis, T., Tychalas, A., Kiourtidis, D., Kountouras, J., Xiromerisiou, G., Rudolf, J., & Deretzi, G. (2017) · The Neurologist · doi:10.1097/nrl.0000000000000125 · Cited by 4 · see citing works
Hypokalemic Periodic Paralysis In A Patient With Euthyroid Graves Disease And Celiac Disease
Rajpal, A., & Sood, A. (2018) · AACE Clinical Case Reports · doi:10.4158/accr-2018-0206 · Cited by 4 · see citing works
Thyrotoxic Periodic Paralysis in a Pediatric Patient
Jones, P., Papadimitropoulos, L., & Tessaro, M. O. (2013) · Pediatric Emergency Care · doi:10.1097/pec.0000000000000033 · Cited by 4 · see citing works
Acute ascending paralysis presenting as an endocrine emergency
Gorchynski, J., Nwosu, H., & Frame, J. (2009) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2008.07.018 · Cited by 4 · see citing works
Comprehensive analysis of acute flaccid paralysis with and without myelitis in Taiwanese children
Lin, C., Fu, R., Chou, I., Chang, Y., & Hong, S. (2025) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-025-01980-2 · Cited by 1 · see citing works
¿Cuándo sospechar una parálisis periódica?: a propósito de un caso
Rodríguez, S. G., Móstoles, N. M., de Paz, I. P., Ranero, C. T., & Blanco, C. P. (2015) · Revista Clínica de Medicina de Familia · doi:10.4321/s1699-695x2015000300013 · Cited by 1 · see citing works
Tirotoksicna periodicna paraliza
Savić, S., Beleslin, B. N., Ciric, S., Stojković, M., Lalić, T., Nišić, T., Stojanovic, M. M., Ćirić, J., & Žarković, M. (2013) · Medicinski glasnik Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor · doi:10.5937/medgla1350035s
Parálisis hipocaliémica tirotóxica: informe de cuatro casos
Carrillo, L. G. D., & Aguilar, J. G. A. (2006) · Acta Médica Grupo Ángeles
Hipoplasia medular por metimazol
Valdivia-Infantas, M. M., Bandrés-Sánchez, M. P., Verona-Rubio, R., Llosa-Isenrich, L., Olivera, M. R. J., Torre-Matuk, A. L., & Verona-Mesía, B. O. (2012) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.36393/spmi.v25i4.394
Thyrotoxic Periodic Paralysis: Case Report and Review of the Literature
Mo, B., Bf, P., & Rl, P. (2008)
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
Bannoud, M., Hong, L., Woo, D., Daniels, Z. R., & Alkatifi, A. (2026) · Cureus · doi:10.7759/cureus.112561
- 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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