Thyrotoxic periodic paralysis due to excessive L-thyroxine replacement in a Caucasian man
Abstract
Thyrotoxic periodic paralysis is a potentially fatal complication of hyperthyroidism, more common in Asian races, which is defined by a massive intracellular flux of potassium. This leads to profound hypokalaemia and muscle paralysis. Although the paralysis is temporary, it may be lethal if not diagnosed and treated rapidly, as profound hypokalaemia may induce respiratory muscle paralysis or cardiac arrest. The condition is often misdiagnosed in the west due to its comparative rarity in Caucasians; however it is now increasingly described in Caucasians and is also being seen with increasing frequency in western hospitals due to increasing immigration and population mobility. Here we describe the case of a patient with panhypopituitarism due to a craniopharyngioma, who developed thyrotoxic periodic paralysis due to excessive L-thyroxine replacement. This disorder has been described in Asian subjects but, to our knowledge, thyrotoxic periodic paralysis secondary to excessive L-thyroxine replacement has never been described in Caucasians.
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TPP occurs from a combination of genetic susceptibility, thyrotoxicosis, and environmental factors.
“Studies have shown that TPP occurs from a combination of genetic susceptibility, thyrotoxicosis, and environmental factors [4].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [4]
This case highlights a rare but important cause of TPP arising from thyroid hormone over-replacement rather than primary thyroid disease, reinforcing that exogenous thyroid hormone excess is a sufficient trigger for TPP in susceptible individuals.
“First, it highlights a rare but important cause of TPP arising from thyroid hormone over-replacement rather than primary thyroid disease, reinforcing that exogenous thyroid hormone excess is a sufficient trigger for TPP in susceptible individuals [4].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [4]
Hannon et al. (2009) reported a case of TPP caused by excessive L-thyroxine replacement in a Caucasian man with panhypopituitarism.
“Hannon et al. (2009) reported a case of TPP caused by excessive L-thyroxine replacement in a Caucasian man with panhypopituitarism.”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [4]
Any cause of thyrotoxicosis, including exogenous thyroid hormone excess, can trigger TPP attacks in susceptible individuals.
“Their case demonstrates that any cause of thyrotoxicosis, including exogenous thyroid hormone excess, can trigger attacks in susceptible individuals [4].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [4]
The recurrence of identical episodes following the same corticosteroid agent and dose further supports the dual-trigger interaction and raises the possibility of underlying genetic susceptibility, such as channelopathies involving CACNA1S or SCN4A variants, which may lower the threshold for paralysis in the setting of thyroid hormone excess.
“The recurrence of identical episodes following the same corticosteroid agent and dose further supports this interaction and raises the possibility of an underlying genetic susceptibility, such as channelopathies involving CACNA1S or SCN4A variants, which may lower the threshold for paralysis in the setting of thyroid hormone excess [4,7].”
From Iatrogenic Thyrotoxicosis and Corticosteroid-Triggered Hypokalemic Periodic Paralysis in a Patient With Treated Hypothyroidism (2026) · cites this paper as [4]
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Treatment with thyroid hormone
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“Studies have shown that TPP occurs from a combination of genetic susceptibility, thyrotoxicosis, and environmental factors [4].”
Influential
- Authors
- Hannon, M. J., Behan, L. A., & Agha, A.
- Affiliations
- Royal College of Surgeons in Ireland (IE)
- Corresponding author
- Agha, A
- ORCID
- Behan, L A
- Venue
- Annals of Clinical Biochemistry International Journal of Laboratory Medicine
- Publisher
- SAGE Publications
- Published
- 2009-07-29
- Volume
- 46
- Issue
- 5
- Pages
- 423-425
- ISSN
- 0004-5632 (ISSN-L)
- 1758-1001
- OpenAlex
- W2083980047
- Cited by
- 22
- References
- 15
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2019: 1 · 2018: 2 · 2015: 2 · 2014: 3 · 2012: 3
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Clinical Biochemistry International Journal of Laboratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (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 › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyrotoxic periodic paralysis, hyperthyroidism, hypokalemia, potassium imbalance, panhypopituitarism, craniopharyngioma, Caucasian patients, thyroid hormone replacement
- MeSH terms
- Adult, Humans, Hypopituitarism, Male, Thyrotoxicosis, Thyroxine, Hypokalemic Periodic Paralysis, White People
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