Thyrotoxic Periodic Paralysis: A Diagnostic Challenge

Kung, Annie W. C.

doi:10.1210/jc.2006-0356

Cited by 371Thyroid Disorders and TreatmentsPotassium and Related DisordersCardiac electrophysiology and arrhythmias

Thyrotoxic Periodic Paralysis: A Diagnostic Challenge

Kung, Annie W. C.·2006·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2006-0356

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Abstract

CONTEXT: The aim of this article was to review the clinical presentation, pathogenesis, and management of thyrotoxic periodic paralysis (TPP). EVIDENCE ACQUISITION: A MEDLINE search was conducted for articles published during the last 40 yr based on the key words thyrotoxic periodic paralysis and hypokalemic periodic paralysis. A total of 281 primary articles and 168 references of the retrieved articles were also reviewed. EVIDENCE SYNTHESIS: TPP is a common complication of hyperthyroidism in Asian men but is increasingly seen in Western countries. Hypokalemia and muscle paralysis results from a sudden intracellular shift of potassium and is not due to potassium deficiency. Clinical features of hyperthyroidism in patients with TPP may be subtle. Immediate potassium supplementation prevents serious cardiopulmonary complications and may hasten the recovery of muscle weakness. Nonselective beta-adrenergic blockers can ameliorate and prevent recurrence of the paralytic attacks. This episodic paralysis will remit with definitive control of hyperthyroidism. Increased sodium-potassium ATPase pump activity and enhanced insulin response in patients with TPP is postulated to contribute to the hypokalemia. The genetic predisposition for TPP is not entirely clear. Association of polymorphisms of the calcium channel alpha1-subunit gene with TPP has been noted. CONCLUSIONS: Due to population mobility, TPP is increasingly common in Western countries. Early diagnosis and prompt treatment prevent life-threatening complications associated with hypokalemia and muscle weakness. Assaying of thyroid function in patients with hypokalemic paralysis distinguishes TPP from other forms of hypokalemic periodic paralysis.

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The consistent temporal link between intra-articular triamcinolone acetonide 40 mg and each paralytic episode with symptom onset within four hours on both occasions highlights corticosteroids as a significant and often overlooked trigger in vulnerable patients.
“Second, the consistent temporal link between intra-articular triamcinolone acetonide 40 mg and each paralytic episode with symptom onset within four hours on both occasions highlights corticosteroids as a significant and often overlooked trigger in vulnerable patients [8].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [8]
THPP episodes are typically transient and self-limiting and are precipitated by factors such as high-carbohydrate meals, physical activity, and β-adrenergic agonists.
“Episodes are typically transient and self-limiting and are precipitated by factors such as high-carbohydrate meals, physical activity, and β-adrenergic agonists [11].”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [11]
A high glucose load, insulin infusion, and exercise test could induce paralysis and weakness during the post-exercise resting period.
“A high glucose load, insulin infusion, and exercise test could induce paralysis and weakness during the post-exercise resting period [6].”
From A Case of Thyrotoxic Periodic Paralysis: "I Can't Move!" (2023) · cites this paper as [6]
Thyrotoxic periodic paralysis typically affects Asian males between the ages of 20 and 40.
“It typically affects Asian males between the ages of 20-40 [4, 5, 6].”
From A Case of Thyrotoxic Periodic Paralysis: "I Can't Move!" (2023) · cites this paper as [6]
THPP occurs more commonly among young Asian men with underlying Graves' disease.
“It occurs more commonly amongst young Asian men with underlying Graves' disease.”
From Thyrotoxic hypokalemic periodic paralysis triggered by dexamethasone administration (2020) · cites this paper as [1]

Isozymes of the Na-K-ATPase: heterogeneity in structure, diversity in function
Blanco, G. V., & Mercer, R. W. (1998) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.1998.275.5.f633 · Cited by 1,247 · see citing works
Principles and Practice of Endocrinology and Metabolism.
(1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-114-9-816_4 · Cited by 804 · see citing works
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
Insulin induces translocation of the alpha 2 and beta 1 subunits of the Na+/K(+)-ATPase from intracellular compartments to the plasma membrane in mammalian skeletal muscle.
Hundal, H. S., Marette, A., Mitsumoto, Y., Ramlal, T., Blostein, R., & Klip, A. (1992) · Journal of Biological Chemistry · doi:10.1016/s0021-9258(18)42725-1 · Cited by 257 · 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
Thyrotoxic periodic paralysis
Lin, S.-H. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.1.99 · Cited by 254 · see citing works
Thyrotoxic Periodic Paralysis
Kelley, D. E. (1989) · Archives of Internal Medicine · doi:10.1001/archinte.149.11.2597 · Cited by 227 · see citing works
THE ASSOCIATION OF PERIODIC PARALYSIS AND HYPERTHYROIDISM IN JAPAN
OKINAKA, S., SHIZUME, K., UNO, S., WATANABE, A., IRIE, M., NOGUCHI, A., KUMA, S., KUMA, K., & ITO, T. (1957) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-17-12-1454 · Cited by 206 · cited 2× · see citing works
“4% among female thyrotoxic patients in 1957 [2] .”
Background
Effect of triiodothyronine on the synthesis and degradation of renal cortical (Na+ + k+)-adenosine triphosphatase
Lo, C.-S., & Edelman, I. S. (1976) · Journal of Biological Chemistry · doi:10.1016/s0021-9258(19)57011-9 · Cited by 185 · see citing works
Oxford Handbook of Endocrinology and Diabetes
(2014) · doi:10.1093/med/9780199644438.001.0001 · Cited by 177 · see citing works
In 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
Increased (Na+,K+)-ATPase concentrations in various tissues of rats caused by thyroid hormone treatment.
Lin, M. H., & Akera, T. (1978) · Journal of Biological Chemistry · doi:10.1016/s0021-9258(17)38162-0 · Cited by 157 · see citing works
Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis
Lin, S.-H., & Lin, Y.-F. (2001) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2001.22090 · Cited by 148 · see citing works
Hypokalaemic paralysis
Ahlawat, S. K., & Sachdev, A. (1999) · Postgraduate Medical Journal · doi:10.1136/pgmj.75.882.193 · Cited by 141 · see citing works
Effects 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
Periodic paralysis and the sodium‐potassium pump
Layzer, R. B. (1982) · Annals of Neurology · doi:10.1002/ana.410110602 · Cited by 122 · see citing works
Thyrotoxic periodic paralysis
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
A Mutation in the KCNE3 Potassium Channel Gene Is Associated with Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis
Dias Da Silva, M. R., Cerutti, J. M., Arnaldi, L. A. T., & Maciel, R. M. B. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-020698 · Cited by 113 · see citing works
Archaeology of NIDDM: Excavation of the “Thrifty” Genotype
Wendorf, M., & Goldfine, I. D. (1991) · Diabetes · doi:10.2337/diab.40.2.161 · Cited by 93 · see citing works
The pitfalls of potassium replacement in thyrotoxic periodic paralysis: a case report and review of the literature
Tassone, H., Moulin, A., & Henderson, S. O. (2004) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2003.05.004 · Cited by 93 · see citing works
Effect of Thyroid Hormone on the Abundance of Na, K-Adenosine Triphosphatase α-Subunit Messenger Ribonucleic Acid*
Chaudhury, S., Ismail‐Beigi, F., GICK, G. G., Levenson, R. G., & Edelman, I. S. (1987) · Molecular Endocrinology · doi:10.1210/mend-1-1-83 · Cited by 86 · see citing works
ASSOCIATION OF HLA ANTIGENS WITH THYROTOXIC GRAVES’ DISEASE AND PERIODIC PARALYSIS IN HONG KONG CHINESE
Hawkins, B. R., C., J. T., Lam, K. S. L., Wang, C. C. L., & YEUNG, R. T. T. (1985) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1985.tb00220.x · Cited by 82 · see citing works
Familial hypokalemic periodic paralysis
Links, T. P., Smit, A. J., Molenaar, W. M., Zwarts, M. J., & Oosterhuis, H. J. G. H. (1994) · Journal of the Neurological Sciences · doi:10.1016/0022-510x(94)90049-3 · Cited by 82 · see citing works
Thyrotoxic Periodic Paralysis With Ventricular Fibrillation
Fisher, J. (1982) · Archives of Internal Medicine · doi:10.1001/archinte.1982.00340200130024 · Cited by 79 · see citing works
Association of Novel Single Nucleotide Polymorphisms in the Calcium Channel α1 Subunit Gene (Cav1.1) and Thyrotoxic Periodic Paralysis
Kung, A. W. C., Lau, K. S., Fong, G. C. Y., & Chan, V. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030924 · Cited by 77 · see citing works
Self-citation
Thyroid-induced alterations in myocardial sodium-potassium-activated adenosine triphosphatase, monovalent cation active transport, and cardiac glycoside binding.
Curfman, G., Crowley, T. J., & Smith, T. W. (1977) · Journal of Clinical Investigation · doi:10.1172/jci108675 · Cited by 75 · 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
Electrocardiographic Manifestations in Patients with Thyrotoxic Periodic Paralysis
Hsu, Y.-J., Lin, Y.-F., Chau, T., Lin, S.-H., Liou, J.-T., & Kuo, S.-W. (2003) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200309000-00004 · Cited by 70 · see citing works
Hyperinsulinaemia in thyrotoxic hypokalaemic periodic paralysis
Lee, K. O., Taylor, E. A., Oh, V. M. S., Cheah, J. S., & Aw, S. E. (1991) · The Lancet · doi:10.1016/0140-6736(91)91710-c · Cited by 69 · see citing works
EFFECT OF PROPRANOLOL
Mendel, D., & Byrne-Quinn, E. (1966) · The Lancet · doi:10.1016/s0140-6736(66)92951-5 · Cited by 67 · 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
Thyrotoxic hypokalemic periodic paralysis.
Schutta, H. S., & Armitage, J. L. (1969) · PubMed · Cited by 66 · see citing works
Acute Hypercapnic Respiratory Failure due to Thyrotoxic Periodic Paralysis
Liu, Y.-C., Tsai, W.-S., Chau, T., & Lin, S.-H. (2004) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200405000-00025 · Cited by 63 · see citing works
HLA and Thyrotoxic Periodic Paralysis in Japanese Patients
TAMAI, H., TANAKA, K., KOMAKI, G., MATSUBAYASHI, S., HIROTA, Y., MORI, K., KUMA, K., KUMAGAI, L. F., & NAGATAKI, S. (1987) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-64-5-1075 · Cited by 62 · see citing works
Manifestation, Management and Molecular Analysis of Candidate Genes in Two Rare Cases of Thyrotoxic Hypokalemic Periodic Paralysis
Schalin‐Jäntti, C., Laine, T., Valli‐Jaakola, K., Lönnqvist, T. R. I., Kontula, K., & Välimäki, M. J. (2005) · Hormone Research in Paediatrics · doi:10.1159/000084689 · Cited by 61 · see citing works
Absence of Ion Channels CACN1AS and SCN4A Mutations in Thyrotoxic Hypokalemic Periodic Paralysis
Ng, W. Y., Lui, K. F., Thai, A. C., & Cheah, J. S. (2004) · Thyroid · doi:10.1089/105072504773297858 · Cited by 57 · see citing works
HLA and thyrotoxic periodic paralysis.
Yeo, P. P., Chan, S. H., Lui, K. F., Wee, G. B., Lim, P., & Cheah, J. S. (1978) · BMJ · doi:10.1136/bmj.2.6142.930 · Cited by 56 · see citing works
Elevated immunoreactive insulin concentration during spontaneous attacks in thyrotoxic periodic paralysis
Shishiba, Y., Shimizu, T., Saito, T., & Shizume, K. (1972) · Metabolism · doi:10.1016/0026-0495(72)90071-6 · Cited by 56 · see citing works
Mutations linked to familial hypokalaemic periodic paralysis in the calcium channel α1 subunit gene (Cav1·1) are not associated with thyrotoxic hypokalaemic periodic paralysis
Dias da Silva, M. R., Cerutti, J. M., Tengan, C. H., Furuzawa, G. K., Vieira, T. C. A., Gabbai, A. A., & Maciel, R. M. B. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01481.x · Cited by 50 · see citing works
Hypokalemic periodic paralysis: an autosomal dominant muscle disorder caused by mutations in a voltage-gated calcium channel
Lapie, P., Lory, P., & Fontaine, B. (1997) · Neuromuscular Disorders · doi:10.1016/s0960-8966(97)00435-5 · Cited by 45 · see citing works
THYROTOXIC PERIODIC PARALYSIS IN A PATIENT ABUSING THYROXINE FOR WEIGHT REDUCTION
Chen, Y., Fang, J., Chang, C.-T., & Chou, H. (2001) · Renal Failure · doi:10.1081/jdi-100001294 · Cited by 43 · see citing works
Ion flux and Na+,K+-ATPase activity of erythrocytes and leucocytes in thyroid disease
Khan, F., & Baron, D. (1987) · Clinical Science · doi:10.1042/cs0720171 · Cited by 42 · see citing works
The exercise test as a monitor of disease status in hypokalaemic periodic paralysis
Tengan, C. H. (2004) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2003.013870 · Cited by 41 · see citing works
Comparison of the Incidence of Association of Periodic Paralysis and Hyperthyroidism in Japan in 1957 and 1991.
SHIZUME, K., Shishiba, Y., Kuma, K., Noguchi, S., Tajiri, J., Ito, K., & Noh, J. Y. (1992) · Endocrinologia Japonica · doi:10.1507/endocrj1954.39.315 · Cited by 40 · see citing works
Relationship between Na+-dependent respiration and Na+ + K+-adenosine triphosphatase activity in the action of thyroid hormone on rat jejunal mucosa
Liberman, U. A., Asano, Y., Lo, C.-S., & Edelman, I. S. (1979) · Biophysical Journal · doi:10.1016/s0006-3495(79)85207-8 · Cited by 39 · see citing works
Thyrotoxic periodic paralysis complicated by near-fatal ventricular arrhythmias.
Loh, K., Pinheiro, L. F., & Ng, K. S. (2005) · PubMed · Cited by 36 · see citing works
Identification of a novel gene of the X,K‐ATPase β‐subunit family that is predominantly expressed in skeletal and heart muscles1
Pestov, N. B., Adams, G. M., Shakhparonov, M. I., et al. (1999) · FEBS Letters · doi:10.1016/s0014-5793(99)00954-0 · Cited by 35 · see citing works
Mutation screening in Chinese hypokalemic periodic paralysis patients
Wang, W., Jiang, L., Ye, L., Zhu, N., Su, T., Guan, L., Li, X., & Ning, G. (2006) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2005.10.020 · Cited by 35 · 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
Effect of intravenous epinephrine on serum magnesium and free intracellular red blood cell magnesium concentrations measured by nuclear magnetic resonance.
Ryzen, E., Servis, K. L., & Rude, R. K. (1990) · Journal of the American College of Nutrition · doi:10.1080/07315724.1990.10720359 · Cited by 32 · see citing works
Thyrotoxic periodic paralysis and polymorphisms of sodium–potassium ATPase genes
Kung, A. W. C., Lau, K. S., Cheung, W. M. W., & Chan, V. (2006) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02442.x · Cited by 31 · see citing works
Self-citation
Case Report: Thyrotoxic Periodic Paralysis in a Latin-American Taking Acetazolamide
Shulkin, D. J., Olson, B. R., & Levey, G. S. (1989) · The American Journal of the Medical Sciences · doi:10.1097/00000441-198905000-00014 · Cited by 31 · see citing works
Thyrotropin-Secreting Pituitary Adenoma Presenting as Hypokalemic Periodic Paralysis
Hsu, F.-S., Chen, H., Chen, Y., Tsai, W.-S., Chau, T., & Lin, S. (2003) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200301000-00011 · Cited by 30 · see citing works
The effect of thyroid hormone treatment on the gene expression and enzyme activity of rat liver sodium-potassium dependent adenosine triphosphatase
Desai-Yajnik, V., Zeng, J., Omori, K., Sherman, J., & Morimoto, T. (1995) · Endocrinology · doi:10.1210/endo.136.2.7835297 · Cited by 27 · see citing works
Thyrotoxic Periodic Paralysis Associated with a Mutation in the Sodium Channel Gene SCN4A
Lane, A., Markarian, K., & Braziunene, I. (2004) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2004.17.12.1679 · Cited by 27 · 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
Thyrotoxic Periodic Paralysis in a Turkish Male; The Recurrence of the Attack after Radioiodine Treatment
Akar, S., Çömlekçi, A., Bırlık, M., Önen, F., Sarı, İ., Gürler, O., Bekiş, R., & Akkoç, N. (2005) · Endocrine Journal · doi:10.1507/endocrj.52.149 · Cited by 25 · see citing works
Thyrotoxic periodic paralysis in a 14-year-old boy
Wong, G., Leung, T. F., Lo, A. F.-C., Ahuja, A. T., & Cheng, P. S. (2000) · European Journal of Pediatrics · doi:10.1007/pl00008375 · Cited by 23 · see citing works
Hypokalemic periodic paralysis. Experimental precipitation with sodium liothyronine
Okihiro, M. M. (1966) · JAMA · doi:10.1001/jama.198.8.949 · Cited by 22 · see citing works
Fatal Hypokalemic Thyrotoxic Periodic Paralysis Presenting as the Sudden, Unexplained Death of a Cambodian Refugee
Randall, B. B. (1992) · American Journal of Forensic Medicine & Pathology · doi:10.1097/00000433-199209000-00006 · Cited by 22 · see citing works
Periodic Paralysis Associated with Hyperthyroidism.
Crane, M. G. (1960) · PubMed · Cited by 20 · see citing works
Thyrotoxic period paralysis: report of three cases and review of the literature.
PAPADOPOULUS, K. I., DIEP, T., Cleland, B., & LUNN, N. W. (1997) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1997.tb00011.x · Cited by 17 · see citing works
ERYTHROCYTE SODIUM‐POTASSIUM PUMP IN THYROTOXIC PERIODIC PARALYSIS
Lam, K. S. L., YEUNG, R. T. T., BENSON, E. A., et al. (1989) · Australian and New Zealand Journal of Medicine · doi:10.1111/j.1445-5994.1989.tb01664.x · Cited by 15 · see citing works
Inadvertent Iodine Excess Causing Thyrotoxic Hypokalemic Periodic Paralysis
Tran, H. A. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2536-a · Cited by 14 · see citing works
Arg16Gly polymorphism in β2‐adrenergic receptor gene is not associated with thyrotoxic periodic paralysis in Korean male patients with Graves’ disease
Kim, T. Y., Song, J. Y., Kim, W. B., & Shong, Y. K. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02264.x · Cited by 13 · see citing works
Thyrotoxic hypokalemic periodic paralysis: report of four cases and review of the literature (1).
Td, T., & Jb, V. (1987) · PubMed · Cited by 13 · see citing works
Thyrotoxic Periodic Paralysis
Kung, A. W. C., & Cheung, C. L. (2011) · doi:10.1093/med/9780198870197.003.0055 · Cited by 9 · see citing works
Self-citation
Association of novel single-nucleotide polymorphisms in the dihydropyridine sensitive L-type Alpha-3 Calcium Channel (CACNL1 α 3) and Thyrotoxic Periodic Paralysis (TPP)
Kung, A., Lau, K., Fong, G., & Chan, V. (2003) · The HKU Scholars Hub (University of Hong Kong) · Cited by 6 · see citing works
Self-citation
Modern physical methods in biochemistry, volume 11B
Watts, A. B. (1990) · FEBS Letters · doi:10.1016/0014-5793(90)81488-a · Cited by 1 · see citing works

Flagged first, then by citations

Sorted by citations

Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis
Ryan, D. P., Dias da Silva, M. R., Soong, T. W., Fontaine, B., Donaldson, M. R., Kung, A. W. C., Jongjaroenprasert, W., Liang, M. C., Khoo, D. H. C., Cheah, J. S., et al. (2010) · Cell · doi:10.1016/j.cell.2009.12.024 · Cited by 311 · see citing works
Self-citation
Thyrotoxicosis
Franklyn, J. A., & Boelaert, K. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60782-4 · Cited by 262 · see citing works
Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis
Wiersinga, W. M., Poppe, K. G., & Effraimidis, G. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(23)00005-0 · Cited by 254 · see citing works
A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants
Chang, 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
Analytic review: thyrotoxic periodic paralysis: a review
Pothiwala, P., & Levine, S. N. (2010) · Journal of Intensive Care Medicine · doi:10.1177/0885066609358849 · Cited by 80 · see citing works
Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks
Hsieh, M. ‐., Lyu, R. ‐., Chang, W. ‐., Chang, K. ‐., Chen, C. ‐., Chang, H. ‐., Wu, Y. ‐., Chen, S. ‐., & Ro, L. ‐. (2008) · European Journal of Neurology · doi:10.1111/j.1468-1331.2008.02132.x · Cited by 78 · 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
Identification and Functional Characterization of Kir2.6 Mutations Associated with Non-familial Hypokalemic Periodic Paralysis
Cheng, C.-J., Lin, S.-H., Lo, Y.-F., Yang, S.-S., Hsu, Y.-J., Cannon, S. C., & Huang, C.-L. (2011) · Journal of Biological Chemistry · doi:10.1074/jbc.m111.249656 · Cited by 65 · 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
Thyrotoxic hypokalaemic periodic paralysis in a Turkish population: three new case reports and analysis of the case series
Cesur, M., Bayram, F., Temel, M. A., Ozkaya, M., Kocer, A., Ertorer, M. E., Koc, F., Kaya, A., & Gullu, S. (2008) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.03014.x · Cited by 45 · see citing works
Genome-wide association study identifies a susceptibility locus for thyrotoxic periodic paralysis at 17q24.3
Cheung, C.-L., Lau, K.-S., Ho, A. Y. Y., Lee, K.-K., Tiu, S.-C., Lau, E. Y. F., Leung, J., Tsang, M.-W., Chan, K.-W., Yeung, C.-Y., et al. (2012) · Nature Genetics · doi:10.1038/ng.2367 · Cited by 41 · see citing works
Self-citation
Thyrotoxic Periodic Paralysis Induced by Pulse Methylprednisolone
Wongraoprasert, S., Buranasupkajorn, P., Sridama, V., & Snabboon, T. (2007) · Internal Medicine · doi:10.2169/internalmedicine.46.0044 · Cited by 37 · see citing works
INa and IKir are reduced in Type 1 hypokalemic and thyrotoxic periodic paralysis
Puwanant, A., & Ruff, R. L. (2010) · Muscle & Nerve · doi:10.1002/mus.21693 · Cited by 32 · see citing works
Thyrotoxic periodic paralysis: A case report and literature review
Patel, M., & Ladak, K. (2021) · Clinical Medicine & Research · doi:10.3121/cmr.2021.1610 · Cited by 27 · see citing works
Thyrotoxic periodic paralysis due to excessive L-thyroxine replacement in a Caucasian man
Hannon, M. J., Behan, L. A., & Agha, A. (2009) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1258/acb.2009.009012 · Cited by 22 · see citing works
Effects of sex steroid hormones, thyroid hormone levels, and insulin regulation on thyrotoxic periodic paralysis in Chinese men
Li, W., Changsheng, C., Jiangfang, F., Bin, G., Nanyan, Z., Xiaomiao, L., Deqiang, L., Ying, X., Wensong, Z., & Qiuhe, J. (2010) · Endocrine · doi:10.1007/s12020-010-9396-3 · Cited by 21 · see citing works
Thyrotoxic periodic paralysis: case report and review of the literature
Vardhan Garla, V., Gunturu, M., Reddy Kovvuru, K., & Abdul Salim, S. (2018) · Electronic Physician · doi:10.19082/7174 · Cited by 20 · see citing works
Thyrotoxic periodic paralysis: diversity in America
Patel, H., Wilches, L. V., & Guerrero, J. (2014) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2013.08.104 · Cited by 19 · see citing works
Thyrotoxic periodic paralysis associated with lactic metabolic acidosis: Case report of an African man and review of literature
Allard, M., Barrallier, M., Pisaroni, H., Fichet, M., De La Vergne De Cerval, M., Pflaum, R., Poisson, A., Derrien, C., Bonnet, F., & Vaduva, P. (2023) · Annales d'Endocrinologie · doi:10.1016/j.ando.2023.01.007 · Cited by 9 · see citing works
Thyrotoxic hypokalemic periodic paralysis triggered by dexamethasone administration
Polamaung, W., Kongkit, J., Yimnoi, P., Boonchaya-Anant, P., & Snabboon, T. (2020) · Acta Medica (Hradec Kralove, Czech Republic) · doi:10.14712/18059694.2020.24 · Cited by 9 · see citing works
Periodic Paralysis: A Case Series with a Literature Review
Al Hariri, B., Hassan, M. A., Sharif, M., Alsakaji, O. A., Hassan, Y. A., & Khalid, M. K. (2024) · Case Reports in Neurology · doi:10.1159/000541585 · Cited by 8 · see citing works
Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia
Mohamed, H. N., Ghedi, A. K. A., Ozturk, S., Jeele, M. O. O., & Bashir, A. M. (2023) · Thyroid Research · doi:10.1186/s13044-023-00158-4 · Cited by 7 · see citing works
Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms
Qing, G., Zakaria, W. N. A., Rom, F. Z. M., Nik, W. N. F. H. W., Zulkeflee, H. A., & Rahim, S. N. A. (2025) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2554 · Cited by 5 · see citing works
“Episodes are typically transient and self-limiting and are precipitated by factors such as high-carbohydrate meals, physical activity, and β-adrenergic agonists [11].”
Graves’ Disease With Initial Presentation of Thyrotoxic Periodic Paralysis
Petty, L., & Kaput, K. (2023) · Cureus · doi:10.7759/cureus.49524 · Cited by 5 · see citing works
Case report: SCN4A p.R1135H gene variant in combination with thyrotoxicosis causing hypokalemic periodic paralysis
Zhang, Z., & Xiao, B. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2022.1078784 · Cited by 5 · see citing works
Thyrotoxic Periodic Paralysis: A Unique Case Highlighting the Diagnostic Challenges and Management
Atrash, J., Musleh, T., Naji, Y., Said, V., & Saraheen, M. (2024) · Cureus · doi:10.7759/cureus.73275 · Cited by 4 · see citing works
A Case of Thyrotoxic Periodic Paralysis: "I Can't Move!"
Basnet, A., Goyal, N., Tiwari, K., Kansakar, S., & Gautam, S. (2023) · Cureus · doi:10.7759/cureus.34301 · Cited by 2 · see citing works
“It typically affects Asian males between the ages of 20-40 [4, 5, 6].”
Background
Thyrotoxic periodic paralysis: diagnostic and management considerations
Alrashedi, F. S., & Alonazi, R. A. (2025) · BMJ Case Reports · doi:10.1136/bcr-2025-269416 · Cited by 1 · see citing works
Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism
Brini, G., Sharron, K., Ahmad, Z., & Madu, C. (2026) · Cureus · doi:10.7759/cureus.109603
“Second, the consistent temporal link between intra-articular triamcinolone acetonide 40 mg and each paralytic episode with symptom onset within four hours on both occasions highlights corticosteroids as a significant and often overlooked trigger in vulnerable patients [8].”

Authors: Kung, A. W. C.
Affiliations: Queen Mary Hospital (CN)
Corresponding author: Kung, Annie W. C.
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2006-07
Volume: 91
Issue: 7
Pages: 2490-2495
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2006-0356
OpenAlex: W1972418047
Cited by: 371
References: 71
Citations by year: 2026: 11 · 2025: 15 · 2024: 21 · 2023: 21 · 2022: 20 · 2021: 22 · 2020: 18 · 2019: 14 · 2018: 16 · 2017: 13 · 2016: 17 · 2015: 24 · 2014: 21 · 2013: 20 · 2012: 29
FWCI: 13.00
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
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 › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: thyrotoxic periodic paralysis, hypokalemic periodic paralysis, hyperthyroidism, hypokalemia, potassium supplementation, beta-blockers, insulin response, genetic susceptibility, muscle weakness, thyroid function tests
MeSH terms: Sodium-Potassium-Exchanging ATPase, Asia, Electromyography, Graves Disease, Humans, Hyperthyroidism, Hypokalemia, Iodine Radioisotopes, Male, Muscular Diseases, Paralysis, Periodicity, Potassium, Potassium Chloride, Antithyroid Agents, Thyroid Hormones, Thyroidectomy, Thyrotoxicosis, Exercise, MEDLINE, Muscle, Skeletal, Hypokalemic Periodic Paralysis

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Thyrotoxic Periodic Paralysis: A Diagnostic Challenge

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