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Cited by 303Thyroid Disorders and TreatmentsPotassium and Related DisordersThyroid and Parathyroid Surgery

Periodic paralysis complicating thyrotoxicosis in Chinese.

Open access
McFadzean, A. J., Yeung, R.·1967·BMJ
DOI 10.1136/bmj.1.5538.451PMC PMC1840834
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Abstract

In Europe and the United States of America periodic paralysis would appear to be a rare complication of thyrotoxicosis.In contrast, in Japan this complication has been reported to occur in some 2% of all thyrotoxic patients, consequently 90% of the case reports in the literature have come-from Japan (Engel, 1961).Before the investigation which is the subject of this communication was made it was apparent to us that periodic paralysis also commonly complicated thyrotoxicosis in the Chinese, yet, strangely, this had not been reported in the literature.Indeed, up to the present there has been but one report of its occurrence in a Chinese in Taiwan (Chen, Hung, and Lin, 1965). Material and MethodsIn the six-year period 1960-5, inclusive, all new patients with thyrotoxicosis attending for the first time the thyroid disease clinic of the University Department of Medicine were questioned specifically on the occurrence of periodic attacks of paralysis.The 25 patients who gave a history of such attacks were admitted to hospital.All were southern Chinese.Throughout their stay in hospital they were encouraged to walk about.Urine was collected for the estimation of the daily excretion of potassium and sodium.From time to time the serum concentrations of potassium, sodium, and inorganic phosphorus were determined.Additionally the daily faecal excretion of potassium was estimated in one patient who had the most frequent and severe spontaneous attacks of paralysis.Eight of the 25 developed one or more spontaneous attacks of paralysis while in hospital, and the serum electrolytes were determined in 13 of these attacks.Attempts were made to induce attacks in 23, including the eight who developed paralysis spontaneously.Since the initial report by Aitken, Allott, Castle- den, and Walker (1937) of its effectiveness-in precipitating attacks of paralysis a combination of insulin and a high carbo- hydrate intake has been widely employed for this purpose in both the familial and thyrotoxic forms of periodic paralysis.Soluble insulin, 30 units, was injected subcutaneously before the midday meal, which included 200 g. of carbohydrate in the form of rice.At 5 p.m. the injection of insulin was repeated, and it was followed by the evening meal, which again included 200 g. of carbohydrate.Between the two meals all patients were encouraged to take glucose drinks and to walk about the hospital.After the evening meal they went to bed, and there- after were under continuous cardiac monitoring.On this regimen 18 of the 23 had an attack of paralysis.Serum electro- lytes were estimated at the height of the paralysis in these 18 and at midnight in the case of the five failures.The five failures were given 9-a-fluorohydrocortisone, 0.6 mg.daily, for from three to five days before a further attempt at induction was made.

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  • The low frequency of high-carbohydrate-provoked TPP in this observation may be related to the westernization of the Asian diet with declining rice intake and increasing protein consumption.

    “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 [22]

    The Discussion (page not available in our copy) identifies high carbohydrate intake as a trigger for individual attacks and suggests that the rice diet’s low potassium-to-carbohydrate ratio may contribute. It does not discuss a westernizing Asian diet, declining rice intake, or increasing protein consumption as an explanation for the citing authors’ low frequency of carbohydrate-provoked attacks. (LLM, conf=0.86)

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  1. N.Y. St. 7. Med., 43, 1951. on 13 September 2023 by guest. Protected by copyright. http://www.bmj.com/ Br Med J: first published as 10.1136/bmj.1.5538.451 on 25 February 1967. Downloaded from

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Authors
McFadzean, A. J., & Yeung, R.
ORCID
McFadzean, A. J.
Venue
BMJ
Publisher
BMJ
Published
1967-02-25
Volume
1
Issue
5538
Pages
451-455
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.1.5538.451
PMC
PMC1840834
OpenAlex
W1972430075
Cited by
303
References
9
Citations by year
2026: 3 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 15 · 2021: 9 · 2020: 8 · 2019: 2 · 2018: 10 · 2017: 4 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 9 · 2012: 14
FWCI
2.02
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (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
periodic paralysis, thyrotoxicosis, thyrotoxic periodic paralysis, Chinese patients, serum potassium, serum sodium, serum phosphorus, potassium excretion, sodium excretion, hypokalemia, hyperkalemia, hypocalcemia, hypomagnesemia, hypophosphatemia, hypoglycemia
MeSH terms
Adult, Arrhythmias, Cardiac, China, Electrocardiography, Female, Humans, Hyperthyroidism, Male, Paralysis, Water-Electrolyte Balance, Asian People

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