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Cited by 56Potassium and Related DisordersThyroid Disorders and TreatmentsCardiac electrophysiology and arrhythmias

Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years

Shiang, Jeng-Chuan, Cheng, Chih-Jen, Tsai, Ming-Kai, Hung, Yi-Jen, Hsu, Yu-Juei, Yang, Sung-Sen, Chu, Shi-Jye, Lin, Shih-Hua·2009·European Journal of Endocrinology
DOI 10.1530/eje-09-0553
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Abstract

Objective: To characterize the course of therapy in a large cohort of Chinese patients with thyrotoxic periodic paralysis (TPP), a reversible electrolyte emergency fraught with therapeutic challenges. Design and methods: In this prospective interventional study, 78 patients with TPP (75 males and three females with an age range of 16–48 years) were consecutively enrolled over a 6-year period. Intravenous KCl at a rate of 10 mmol/h was administered until muscle strength recovered. Serum potassium (K+) and phosphorus concentrations were measured hourly during the paralytic attack and for 6 h after recovery. Results: The serum potassium (K+) on attack was 2.1±0.2 mmol/l. The dose of KCl administered to restore muscle strength was 63±32 mmol, and peak serum K+ concentration after recovery was 5.3±0.5 mmol/l. A paradoxical fall in serum K+ concentration >0.1 mmol/l difference between presentation and treatment nadir was observed in approximately one-fourth of TPP patients (n=20). These patients had significantly higher serum-free thyroxine concentration, systolic blood pressure, and heart rate on presentation, as well as serum phosphate concentration on recovery. They not only needed much more KCl supplementation (104±34 vs 48±19 mmol, P<0.001), but also had significantly more severe rebound hyperkalemia (5.8±0.5 vs 5.1±0.4 mmol/l, P<0.001) on recovery than those who did not have paradoxical hypokalemia. There was a positive correlation between the dose of KCl administered and the difference between peak and nadir serum K+ (Δ K+) (r=0.68, P<0.001). Conclusions: TPP patients who do not develop paradoxical hypokalemia need a smaller KCl dose to achieve recovery, whereas those who develop paradoxical hypokalemia have more severe hyperthyroidism and hyperadrenergic activity and may require blockage of intracellular K+ shift to prevent rebound hyperkalemia.

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Authors
Shiang, J.-C., Cheng, C.-J., Tsai, M.-K., Hung, Y.-J., Hsu, Y.-J., Yang, S.-S., Chu, S.-J., & Lin, S.-H.
Affiliations
Zuoying Armed Forces General Hospital (TW)
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2009-12
Volume
161
Issue
6
Pages
911-916
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-09-0553
OpenAlex
W2138256148
Cited by
56
References
40
Citations by year
2026: 1 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 3 · 2012: 10
FWCI
3.93
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
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 › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
thyrotoxic periodic paralysis, serum potassium, hyperthyroidism, serum phosphorus, Chinese patients
MeSH terms
Adolescent, Adult, Female, Humans, Male, Middle Aged, Paralyses, Familial Periodic, Potassium, Potassium Chloride, Hypokalemic Periodic Paralysis

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