Chronic Alcohol Abuse-Induced Hypokalemia Might Lead to Delayed Diagnosis or Misdiagnosis of Thyrotoxic Periodic Paralysis
Open accessAbstract
Thyrotoxic periodic paralysis is an uncommon and potentially life-threatening complication of thyrotoxicosis and hyperthyroidism characterized by acute and reversible episodes of muscle weakness and hypokalemia. Here is a 41-year-old Taiwanese male patient without any family history of hyperthyroidism presented to the emergency room of our institution with initial symptom of acute lower limb weakness. Laboratory analysis revealed uncommonly severe hypokalemia (<1.5 mEq/L). A thyroid function test revealed hyperthyroidism, and thyroid ultrasonography revealed findings compatible with Graves' disease. However, symptoms such as nausea, vomiting, diarrhea, and heavy breathing were absent. He was administered with 15 mg of methimazole and 30 mg of propranolol per day for complications of hyperthyroidism. Then we exhaustively evaluated the patient's history and lifestyle habits, and found that the patient had chronic alcohol abuse (an 1-L bottle 45%-48% liquor per week) for more than 10 years. In this case, chronic alcohol abuse may have increased the patient's tolerance to the profound hypokalemia such that it did not immediately show critical symptoms. Therefore, according to this case report, we suggest that chronic alcohol consumption or abuse may lead patients, especially those with hyperthyroidism, to ignore or delay treatment.
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Diminished efflux through outwardly rectifying potassium channels can produce paradoxical depolarization, which inactivates sodium channels and further impairs muscle excitability.
“At the same time, diminished efflux through outwardly rectifying potassium channels can produce paradoxical depolarization [35]. This depolarization inactivates sodium channels and further impairs muscle excitability.”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [35]
The Discussion describes increased potassium influx through Na+/K+ ATPase activity and associates hypokalemia with muscle weakness. It does not address diminished efflux through outwardly rectifying potassium channels, paradoxical depolarization, or sodium-channel inactivation (searched: outwardly rectifying potassium channels, paradoxical depolarization, sodium-channel inactivation, muscle excitability). (LLM, conf=0.73)
Experimental — accuracy not yet measuredDuring a THPP attack, muscle cells exhibit proliferation and focal dilatation of the sarcoplasmic reticulum and transverse tubular system, forming vacuoles, and these changes are consistently observed during attacks and less prominent between episodes.
“Furthermore, during a THPP attack, muscle cells exhibit proliferation and focal dilatation of the sarcoplasmic reticulum and transverse tubular system, forming vacuoles. These changes are consistently observed during attacks and are less prominent between episodes [35].”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [35]
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Cites
De Leo, S., Lee, S. Y., & Braverman, L. E. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00278-6 · Cited by 883 · see citing works
Gennari, F. J. (1998) · New England Journal of Medicine · doi:10.1056/nejm199808133390707 · Cited by 565 · see citing works
Lin, S.-H. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.1.99 · Cited by 254 · see citing works
Catecholamine-thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism
Levey, G. S., & Klein, I. L. (1990) · The American Journal of Medicine · doi:10.1016/0002-9343(90)90533-j · Cited by 212 · see citing works
Ertek, S., & Cicero, A. F. G. (2013) · Archives of Medical Science · doi:10.5114/aoms.2013.38685 · Cited by 131 · see citing works
Impact of alcohol use on thyroid function
Balhara, Y. P. S., & Deb, K. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.113724 · Cited by 116 · see citing works
EFFECT OF THYROID FUNCTION ON NUMBER OF Na-K PUMPS IN HUMAN SKELETAL MUSCLE
Kjeldsen, K. P., Gøtzsche, C.-O., Clausen, T., Nørgaard, A., & Thomassen, A. R. (1984) · The Lancet · doi:10.1016/s0140-6736(84)91996-2 · Cited by 113 · see citing works
Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorder
Palmer, B. F., & Clegg, D. J. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1704724 · Cited by 111 · see citing works
Ginsberg, A. M., Clutter, W. E., Shah, S. D., & Cryer, P. E. (1981) · Journal of Clinical Investigation · doi:10.1172/jci110218 · Cited by 99 · cited 1× · see citing works
“Hyperthyroidism can induce hyperadrenergic conditions by a chemical structure similar to that of catecholamines, activation of Na+/K+ ATPase, and increase of the sensitivity of ꞵ-receptors [18,19].”
BackgroundBinder, M. D., Hirokawa, N., & Windhorst, U. (2008) · Springer eBooks · doi:10.1007/978-3-540-29678-2_6003 · Cited by 78 · see citing works
Management of Severe Hypokalemia in Hospitalized Patients
Paltiel, O., Salakhov, E., Ronen, I., Berg, D., & Israeli, A. (2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.8.1089 · Cited by 76 · see citing works
Acid-base and electrolyte abnormalities in alcoholic patients.
Elisaf, M., Merkouropoulos, M. H., Tsianos, E. V., et al. (1994) · PubMed · Cited by 64 · see citing works
Hypokalaemia in alcoholic patients
Elisaf, M., Liberopoulos, E. N., Bairaktari, E. T., & Siamopoulos, K. C. (2002) · Drug and Alcohol Review · doi:10.1080/09595230220119282a · Cited by 51 · see citing works
Thyrotoxic Periodic Paralysis: A Case Report and Literature Review
Barahona, M. J., Vinagre, I., Sojo, L., Cubero, J. M., & Pérez, A. M. (2009) · Clinical Medicine & Research · doi:10.3121/cmr.2009.816 · Cited by 31 · see citing works
Thyrotoxic Periodic Paralysis: An Underdiagnosed and Underrecognized Condition
Tella, S. H., & Kommalapati, A. (2015) · Cureus · doi:10.7759/cureus.342 · Cited by 22 · see citing works
Thyrotoxic periodic paralysis: Two case studies
DARROW, M., Brammer, W. K., & Rowley, A. (1995) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(95)80641-5 · Cited by 15 · see citing works
Hyperthyroid hypokalemicperiodic paralysis
Neki, N. S. (2016) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.324.11006 · Cited by 14 · see citing works
Affram, K. O., Reddy, T. L., & Osei, K. M. (2018) · American Journal of Case Reports · doi:10.12659/ajcr.911270 · Cited by 13 · see citing works
Hagel, S., Elznerova, T., Dietrich, W., Schrauzer, T., & John, S. (2009) · Cases Journal · doi:10.4076/1757-1626-2-7501 · Cited by 9 · see citing works
Kurajoh, M., Ohsugi, K., Kakutani‐Hatayama, M., et al. (2018) · CEN Case Reports · doi:10.1007/s13730-018-0315-4 · Cited by 6 · see citing works
Pop-provoked paralysis: silent Graves’ disease presenting as thyrotoxic periodic paralysis
Sehmer, B., & Arnason, T. (2012) · BMJ Case Reports · doi:10.1136/bcr-2012-006292 · Cited by 2 · see citing works
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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
“At the same time, diminished efflux through outwardly rectifying potassium channels can produce paradoxical depolarization [35].”
Influential
- Authors
- Lin, Y.-Y., & Hsieh, Y.-S.
- Affiliations
- Taipei Medical University Hospital (TW)
- National Taipei University of Nursing and Health Science (TW)
- Corresponding author
- Hsieh, Yu-Shan
- ORCID
- Hsieh, Yu-Shan
- Venue
- Cureus
- Published
- 2021-06-23
- Volume
- 13
- Issue
- 6
- Pages
- e15880-e15880
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC8312769
- OpenAlex
- W3175610837
- Cited by
- 6
- References
- 21
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- 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 › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- thyrotoxic periodic paralysis, hypokalemia, chronic alcohol abuse, hyperthyroidism, Graves' disease, delayed diagnosis, misdiagnosis, alcohol tolerance, muscle weakness, methimazole, propranolol
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