Intravenous methylprednisolone-induced hypokalaemic periodic paralysis in a thyrotoxic patient: a case report and literature review
Abstract
Hypokalaemic periodic paralysis (HPP) is an uncommon complication of corticosteroid therapy, which may also be seen in thyrotoxicosis. It was mostly described in the Asian population, and it is rare in other ethnic groups. We present the case of a poorly controlled thyrotoxic Caucasian male with thyroid eye disease (TED) who suffered an acute quadriplegic episode caused by severe hypokalaemia and was admitted to the intensive care unit (ITU) within 24 hours of initiating intravenous methylprednisolone (IVMP) infusion. Once his potassium blood levels were repleted, he completely recovered from the episode. Although HPP is rare in the Caucasian population, it can be precipitated in thyrotoxic patients by systemic steroids. Caution should be exercised when administering IVMP in poorly controlled thyrotoxic patients, and we suggest monitoring the potassium levels at regular intervals with ECG monitoring for at least 24 hours in at-risk individuals.
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Triamcinolone's combined glucocorticoid and mineralocorticoid activity, together with its capacity to induce transient hyperglycemia and hyperinsulinemia, provides a plausible mechanistic basis for the precipitated potassium shift.
“Triamcinolone's combined glucocorticoid and mineralocorticoid activity, together with its capacity to induce transient hyperglycemia and hyperinsulinemia, provides a plausible mechanistic basis for the precipitated potassium shift [6].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [6]
Glucocorticoids promote hypokalemia through mineralocorticoid activity and can cause hyperglycemia and hyperinsulinemia, which can further increase intracellular potassium uptake and precipitate TPP episodes.
“Glucocorticoids promote hypokalemia through mineralocorticoid activity and can cause hyperglycemia and hyperinsulinemia, which can further increase intracellular potassium uptake and can precipitate TPP episodes [6].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [6]
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References 32 · Cited by 6
- Authors
- Wanas, A. M., Giacuzzo, C., Ghazi-Nouri, S., & Tan, L. T.
- Affiliations
- Department of Ophthalmology, Mid and South Essex NHS Foundation Trust, Essex, UK
- Corresponding author
- Wanas, Ahmed Magid
- Venue
- Orbit
- Publisher
- Informa UK Limited
- Published
- 2024-01-08
- Volume
- 44
- Issue
- 1
- Pages
- 77-81
- ISSN
- 0167-6830 (ISSN-L)
- 1744-5108
- OpenAlex
- W4390667051
- Cited by
- 6
- References
- 32
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Orbit (publishedVersion)
- PubMed (publishedVersion)
- Funders
- no funding associated
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- hypokalemic periodic paralysis, methylprednisolone, thyrotoxicosis, corticosteroid-induced complications, hypokalemia, Graves' ophthalmopathy, potassium monitoring, ECG monitoring, Caucasian patients
- MeSH terms
- Adult, Electrocardiography, Glucocorticoids, Humans, Infusions, Intravenous, Male, Methylprednisolone, Middle Aged, Potassium, Quadriplegia, Thyrotoxicosis, Hypokalemic Periodic Paralysis, White People, Graves Ophthalmopathy
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