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Thyrotoxic Periodic Paralysis in the United States Report of 7 Cases and Review of the Literature
Abstract
Although hypokalemic periodic paralysis is a common complication of hyperthyroidism among Asian populations, it is an uncommon problem in the United States. The recent experience in an American medical center with 7 patients with thyrotoxic periodic paralysis (TPP) is reviewed. Compared to most descriptions of this disorder, which tend to reflect the international experience with this disease, patients with TPP in the United States reflect the ethnic makeup of the local population: the predisposition of patients of Asian origin is very evident, but whites are more frequently affected than most previous reports have recognized. Hispanics and American Indians also appear to be at increased risk, and blacks have also been affected. Except for the fact that hyperthyroidism is an absolute requirement for expression of the disease, TPP is identical to familial periodic paralysis (FPP) in its clinical presentation. TPP affects predominantly males (to an even greater degree than FPP), is rarely associated with a positive family history, and has a later onset of presentation than FPP (reflecting the need for hyperthyroidism to occur before the disorder can be expressed). Graves disease is the most common cause of hyperthyroidism in affected patients, but any cause of thyrotoxicosis (including administration of excessive amounts of exogenous thyroid hormone) can trigger attacks of TPP in susceptible subjects. Clinical features of thyroid disease may be very subtle or virtually nonexistent; as a result, thyroid function tests should be routinely monitored in patients with features of hypokalemic paralysis. The pathophysiology of the disorder is not well understood. Definitive treatment of hyperthyroidism leads to cessation of periodic hypokalemic paralysis, but symptoms can return with recurrence of the hyperthyroid condition. Potassium administration during an acute attack will shorten the duration of the episode, and treatment with propranolol, potassium supplementation, or spironolactone may prevent attacks in some patients.
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“The low frequency of high-carbohydrate-provoked TPP in our observation may be related to the westernization of the Asian diet with declining rice intake and increasing protein consumption (14, 22).”
From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [14]
In the citing paper
“According to previous reports, nearly 50% of TPP patients had only subtle signs/symptoms of thyrotoxicosis, albeit without systematic assessment (14, 15, 16, 36).”
From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [14]
In the citing paper
“It is often stated in the literature that typical clinical symptoms of thyrotoxicosis, such as weight loss, heat intolerance, palpitations, increased appetite, excitability, and diaphoresis, may be subtle and periodic paralysis may precede these symptoms in TPP (10, 14, 15, 16).”
From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [14]
In the citing paper
“The precipitating factors of TPP reported in the literature included high carbohydrate ingestion, strenuous exercise, trauma, acute upper respiratory tract infection (URI), high-salt diet, emotional stress, exposure to cold, alcohol ingestion, menstruation, and use of drugs such as corticosteroids, epinephrine, acetazolamide, and non-steroidal anti-inflammatory drugs (2, 3, 14, 22, 23, 24).”
From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [14]
In the citing paper
“It has also been reported from the western countries as a result of migration of different ethnic populations [3].”
From Thyrotoxic Periodic Paralysis: Clinical Challenges (2014) · cites this paper as [3]
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Brandenburg, V. M., Knackstedt, C., Gobbelé, R., Graf, J., Schröder, J., Westerhuis, R., & Kosinski, C. M. (2004) · Der Nervenarzt · doi:10.1007/s00115-004-1707-6 · Cited by 5
“Bei den hypokaliämischen periodischen Lähmungen sind ätiologisch zwar heterogene, aber klinisch homogene sporadische, familiäre und thyreotoxische Formen zu unterscheiden [17, 22].”
BackgroundInfluentialThyrotoxic hypokalaemic periodic paralysis
Ben-David, D., Malnick, S. D. H., Evron, E., & Geltner, D. (1997) · The Lancet · doi:10.1016/s0140-6736(05)61794-1 · Cited by 2
Tomer, Y., Greenberg, D. A., & Davies, T. F. (1999) · Humana Press eBooks · doi:10.1007/978-1-59259-704-8_3 · Cited by 2
Graves’ Disease Following SARS-CoV-2 Infection Presenting as Acute Flaccid Quadriparesis
Shetty, A. J., Devi, K. B., Walia, R., & Bhadada, S. K. (2025) · Neurology India · doi:10.4103/ni.ni_1044_22 · Cited by 1
Glucocorticoid-induced Thyrotoxic Periodic Paralysis Following Lumbar Nerve Root Block
Uda, S., Shimizu, H., & Nishioka, H. (2025) · Internal Medicine · doi:10.2169/internalmedicine.5987-25 · Cited by 1
“Factors that may precipitate TPP include high carbohydrate intake, stress, strenuous exercise, acute upper respiratory tract infection, a high-salt diet, alcohol consumption, and exposure to low temperatures (3).”
Complications of Hyperthyroidism
Sayın, İ., Ertek, S., & Cesur, M. (2014) · InTech eBooks · doi:10.5772/58196 · Cited by 2
“Because of this transport of the potassium, periodic and paralytic attacks usually occur during resting time [349].”
BackgroundNagele, W., Hörmann, J., & Nagele, J. (2009) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-009-0644-1 · Cited by 1
“In China and Japan the incidence is 2–24% [ 8 , 9]. In Western societies there are merely isolated reports and an incidence cannot be given.”
BackgroundParálisis periódica hipokalémica tirotóxica: reporte de un caso y revisión del tema
Rueda, S. M. A., & Albarrán, L. Á. R. (2013) · Medunab · doi:10.29375/01237047.1763 · Cited by 1
Metadata
- Authors
- OBER, K. P.
- Affiliations
- Atrium Health Wake Forest Baptist (US)
- Corresponding author
- OBER, K. PATRICK
- Venue
- Medicine
- Published
- 1992-05
- Volume
- 71
- Issue
- 3
- Pages
- 109-120
- ISSN
- 0025-7974 (ISSN-L)
- OpenAlex
- W1998130848
- Cited by
- 289
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 11 · 2022: 11 · 2021: 9 · 2020: 10 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 11 · 2013: 8 · 2012: 11
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Potassium and Related Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- thyrotoxic periodic paralysis, hypokalemic periodic paralysis, hyperthyroidism, Graves' disease, familial periodic paralysis, ethnic distribution, thyrotoxicosis, potassium supplementation, propranolol, spironolactone, hyperthyroidism treatment
- MeSH terms
- Adult, Female, Humans, Hyperthyroidism, Hypokalemia, Male, Paralysis, United States
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