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Cited by 7Thyroid Disorders and TreatmentsMuscle and Compartmental DisordersPotassium and Related Disorders

Steroids and thyrotoxicosis precipitate periodic paralysis

Open access
Ahamed, Rizwan, McCalley, Sarah, Sule, Anupam A·2018·Cureus
DOI 10.7759/cureus.2106PMC PMC5866117
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Abstract

Thyrotoxic Periodic Paralysis (TPP) belongs to a group of muscle diseases called channelopathies, which present with painless generalized muscle weakness without exertion. TPP can be precipitated by a large carbohydrate meal, stress, strenuous exercise, alcohol, a high-salt diet, menstruation, and cold temperatures. Rarely, steroids such as dexamethasone can also precipitate a TPP attack. A 29-year-old Hispanic male, with a history of hyperthyroidism, presented to the emergency department with progressive weakness, predominantly in the lower extremities since morning. Earlier that day, the patient was seen in the same emergency department for difficulty in swallowing. He was diagnosed with uvulitis and received intramuscular dexamethasone and was discharged with amoxicillin for ten days. At home, he started to develop cramps in his lower extremities associated with paresthesias, which progressed to severe weakness to the point where he could not get out of bed. He returned to the hospital and revealed that he had suffered a similar episode following a steroid injection five years ago. He had not sought medical attention as it resolved spontaneously. He denied strenuous exercise, carbohydrate-rich meal, or alcohol ingestion. The patient had been noncompliant with atenolol and methimazole for the past month after losing his medical insurance. On examination, the patient appeared alert and calm. His vitals were significant for tachycardia of 123 beats per minute. Thyromegaly and tenderness were absent on examination of the neck. Muscle strength was 5/5 in the ankle dorsiflexors and ankle plantar flexors bilaterally, but the strength of the iliopsoas, quadriceps, and hamstrings was only 2/5 bilaterally. Deep tendon reflexes were diminished throughout to 1+. Laboratory findings were significant for profound hypokalemia, hypophosphatemia, low thyroid stimulating hormone, and elevated free T3 and T4 levels suggestive of hyperthyroidism. His electrolytes were replaced aggressively and his home medications were restarted. His electrolyte imbalance corrected and his symptoms resolved within a day and he was discharged home. The overwhelming majority of TPP cases reported are male patients, hence this case demonstrates the need to be aware of this complication while treating hyperthyroid male patients with steroids. Hyperthyroidism potentiates catecholamine-mediated Na/K ATPase transport of potassium into the cells. Glucocorticoids are used in the treatment of thyroid storm as it prevents the peripheral conversion of T4 to T3. Moreover, glucocorticoids increase glucose levels stimulating insulin release, which shifts potassium intracellularly accentuating muscle weakness. Although the incidence of glucocorticoids causing TPP is low and not many cases are documented, it is still an important condition to be aware of and can have major clinical implications. Clinicians should be aware of this small subset of hyperthyroidism patients where the use of glucocorticoids can precipitate paralysis.

AI snapshot

Written from the paper’s full text.

TL;DR

A 29-year-old Hispanic man with untreated hyperthyroidism developed thyrotoxic periodic paralysis after a single intramuscular dose of dexamethasone, with profound hypokalemia and rapid recovery after electrolyte replacement. The authors argue clinicians should recognize glucocorticoids as a potential precipitant of TPP in hyperthyroid patients.

Key findings

  • A 29-year-old Hispanic male with hyperthyroidism developed progressive lower-extremity weakness after receiving intramuscular dexamethasone 10 mg for uvulitis; laboratory findings included potassium 2.0 mEq/L, phosphorus 1.4 mg/dL, TSH ≤0.03 miu/ml, free T4 2.97 ng/dL, random glucose 242 mg/dL, bicarbonate 18 mEq/L, and normal creatinine kinase 94 units/L.
  • He improved and his weakness resolved within 24 hours after receiving 140 mEq potassium and 15 mmol intravenous phosphate; he had a prior similar episode after a steroid injection five years earlier and had been noncompliant with atenolol and methimazole for one month.
  • The authors cite that out of 135 patients with TPP, only one was precipitated by steroids; prior reports include three cases with prednisone, two with methylprednisolone, and one with hydrocortisone, and they state this is the first case report of an attack precipitated by a single dose of dexamethasone.
  • Proposed mechanism: thyroid hormone sensitizes adrenergic receptors and stimulates Na+/K+ ATPase, shifting potassium intracellularly; corticosteroids increase Na+/K+ ATPase molecules and can cause hyperglycemia-mediated insulin release, further shifting potassium intracellularly.

Methods

  • Design: single case report.
  • Data/sample: a 29-year-old Hispanic male with hypertension and hyperthyroidism who presented to the emergency department with progressive weakness and paralysis after intramuscular dexamethasone 10 mg; clinical examination, laboratory tests, and electrocardiogram were reported.
  • Main analysis: descriptive clinical correlation; diagnosis of dexamethasone-induced TPP was based on acute hypokalemic muscle weakness in a hyperthyroid patient after corticosteroid administration plus a history of a previous similar episode. No formal statistical analysis was performed.

Limitations

  • The paper does not include a formal limitations section. It states that all cited steroid-precipitated TPP cases had a co-precipitating factor, and notes that in this case the pharyngitis/respiratory tract infection could be considered a co-precipitating factor.
  • Evident from the text: this is a single case report, so causality cannot be proven and incidence cannot be estimated.
  • Evident from the text: no genetic testing for Kir2.6 or other channelopathy mutations is reported, and the patient had been noncompliant with methimazole and atenolol for one month, leaving hyperthyroidism uncontrolled as a possible contributing factor.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.7759/cureus.2106

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Rarely, steroids such as dexamethasone can precipitate a TPP attack.

    “Rarely, steroids such as dexamethasone can also precipitate a TPP attack.”
    • Also stated in: § Discussion · plain
      “There have been three case reports of prednisone [4-6], two of methylprednisolone [7-8], and one of hydrocortisone [9] precipitating TPP.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [4] Thyrotoxic peroidic paralysis in a Hispanic man after the administration of prednisone Endocr Pract Liu Z Braverman LE Malabanan A 427 431 12 2006 16901800

      Not checked in the free run.

    • cites [5] Levothyroxine and prednisone causing generalized weakness in a middle-aged man Case Rep Endocrinol Word A Davidson K Elsayed E 616930 2012 2012 23119192 PMC3483653

      Not checked in the free run.

    • cites [6] Thyrotoxic periodic paralysis (TPP) in a 28-year-old Sudanese man started on prednisone J Am Board Fam Med Tessier JJ Neu SK Horning KK 551 554 23 2010 20616298

      Not checked in the free run.

    • cites [7] Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy Hormones (Athens) Tigas S Papachilleos P Ligkros N Andrikoula M Tsatsoulis A 313 316 10 2011 http://www.hormones.gr/745/article/article.html 22281888

      Not checked in the free run.

    • cites [8] Thyrotoxic periodic paralysis induced by pulse methylprednisolone Intern Med Wongraoprasert S Buranasupkajorn P Sridama V Snabboon T 1431 1433 46 2007 https://www.jstage.jst.go.jp/article/internalmedicine/46/17/46_17_1431/_article 17827844

      Not checked in the free run.

    • cites [9] A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone J Clin Diagn Res Chakrabarti S 271 274 6 2015 PMC4367059 25810683

      Not checked in the free run.

  • Interpretationreasoning

    The resulting hypokalemia in a patient with thyrotoxicosis can precipitate a TPP attack if the patient has a mutation predisposing to periodic paralysis (e.g., Kir channelopathy).

    “The resulting hypokalemia in a patient with thyrotoxicosis can precipitate a TPP attack if the patient has a mutation predisposing to periodic paralysis (e.g., Kir channelopathy).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Thyroid hormone (hyperthyroidism) sensitizes adrenergic receptors and stimulates Na+/K+ ATPase channels in skeletal muscle, causing potassium influx into cells.
    • Rests on an assumption: Glucocorticoids increase glucose levels, stimulating insulin release, which shifts potassium intracellularly and accentuates muscle weakness.
    • Rests on an assumption: Corticosteroids increase the number of Na+/K+ ATPase molecules in skeletal muscle.
  • Premisecitation

    A Kir 2.6 mutation has been found in over a third of patients with TPP.

    “A mutation in this gene alters muscle membrane excitability, decreasing the ability of muscles to respond to stimulation and has been found in over a third of the patients with TPP.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis Cell Ryan DP da Silva MRD Soong TW 88 98 140 2010 20074522 PMC2885139

      Not checked in the free run.

  • Interpretationown data

    The use of glucocorticoids in the presence of hyperthyroidism can precipitate TPP in a subset of patients.

    “Physicians should be aware that the use of glucocorticoids in the presence of hyperthyroidism can precipitate TPP in a subset of patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Thyroid hormone (hyperthyroidism) sensitizes adrenergic receptors and stimulates Na+/K+ ATPase channels in skeletal muscle, causing potassium influx into cells.
    • Rests on an assumption: Glucocorticoids increase glucose levels, stimulating insulin release, which shifts potassium intracellularly and accentuates muscle weakness.
    • Rests on an assumption: Corticosteroids increase the number of Na+/K+ ATPase molecules in skeletal muscle.
  • Premisecitation

    All of the previously reported cases of steroid-precipitated TPP had a coprecipitating factor.

    “All of these cases had a coprecipitating factor.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [4] Thyrotoxic peroidic paralysis in a Hispanic man after the administration of prednisone Endocr Pract Liu Z Braverman LE Malabanan A 427 431 12 2006 16901800

      Not checked in the free run.

    • cites [5] Levothyroxine and prednisone causing generalized weakness in a middle-aged man Case Rep Endocrinol Word A Davidson K Elsayed E 616930 2012 2012 23119192 PMC3483653

      Not checked in the free run.

    • cites [6] Thyrotoxic periodic paralysis (TPP) in a 28-year-old Sudanese man started on prednisone J Am Board Fam Med Tessier JJ Neu SK Horning KK 551 554 23 2010 20616298

      Not checked in the free run.

    • cites [7] Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy Hormones (Athens) Tigas S Papachilleos P Ligkros N Andrikoula M Tsatsoulis A 313 316 10 2011 http://www.hormones.gr/745/article/article.html 22281888

      Not checked in the free run.

    • cites [8] Thyrotoxic periodic paralysis induced by pulse methylprednisolone Intern Med Wongraoprasert S Buranasupkajorn P Sridama V Snabboon T 1431 1433 46 2007 https://www.jstage.jst.go.jp/article/internalmedicine/46/17/46_17_1431/_article 17827844

      Not checked in the free run.

    • cites [9] A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone J Clin Diagn Res Chakrabarti S 271 274 6 2015 PMC4367059 25810683

      Not checked in the free run.

  • Classified as probably not a substantial claim. 17
  • May combine two claims. 10
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The patient had been noncompliant with atenolol and methimazole for the past month after losing his medical insurance.

    “The patient had been noncompliant with atenolol and methimazole for the past month after losing his medical insurance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient had tachycardia of 123 beats per minute.

    “His vitals were significant for tachycardia of 123 beats per minute.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The patient denied strenuous exercise, carbohydrate-rich meal, or alcohol ingestion.

    “He denied strenuous exercise, carbohydrate-rich meal, or alcohol ingestion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Findingnone given

    The patient's weakness resolved within 24 hours after electrolyte replacement and restarting methimazole and atenolol.

    “The patient’s weakness improved and gradually resolved within 24 hours.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient had profound hypokalemia (potassium 2.0 mEq/L) and hypophosphatemia (phosphorus 1.4 mg/dL) during the episode.

    “He was hypokalemic with a potassium of 2.0 mEq/L and hypophosphatemic with a phosphorus of 1.4 mg/dL.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient's weakness was accompanied by paresthesias without sensory loss.

    “This was accompanied by paresthesias without sensory loss.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The patient did not have rhabdomyolysis, with a normal creatinine kinase of 94 units/L.

    “He did not have rhabdomyolysis with a normal creatinine kinase of 94 units/L.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    After returning home, the patient developed cramps in his bilateral lower extremities that progressed to severe weakness to the point where he could not get out of bed.

    “Upon returning home, he started to develop cramps in his bilateral lower extremities that progressed to severe weakness to the point where he could not get out of bed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient's random blood glucose was 242 mg/dL.

    “His random blood glucose was 242 mg/dL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient's muscle strength was 5/5 in the ankle dorsiflexors and ankle plantar flexors bilaterally, but 2/5 in the iliopsoas, quadriceps, and hamstrings bilaterally.

    “Muscle strength was 5/5 in the ankle dorsiflexors and ankle plantar flexors bilaterally, but the strength of the iliopsoas, quadriceps, and hamstrings was only 2/5 bilaterally.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient had hyperthyroidism with suppressed TSH <=0.03 miu/ml and elevated free T4 2.97 nanogram/dL.

    “He had hyperthyroidism with a significantly suppressed thyroid stimulating hormone (TSH) of <=0.03 miu/ml in the presence of elevated free thyroxine-4 (T4) of 2.97 nanogram/dL.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient had a similar episode following a steroid injection five years ago.

    “Focused history taking revealed the patient had suffered from a similar episode following a steroid injection five years ago.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient's deep tendon reflexes were diminished throughout to 1+.

    “Deep tendon reflexes were diminished throughout to 1+.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    A 29-year-old Hispanic male with a past medical history of hypertension and hyperthyroidism presented to the emergency department with progressive weakness and paralysis.

    “A 29-year-old Hispanic male with a past medical history of hypertension and hyperthyroidism presented to the emergency department complaining of progressive weakness and paralysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    TPP has been predominantly reported in young male patients of Asian descent.

    “TPP has been predominantly reported in young male patients of Asian descent [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants Eur J Endocrinol Chang CC Cheng CJ Sung CC Chiueh TS Lee CH Chau T 529 536 169 2013 http://www.eje-online.org/content/169/5/529.long 23939916 PMC3789562

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Thyrotoxic periodic paralysis (TPP) is caused by an intracellular shift of potassium precipitated by increased levels of thyroid hormones.

    “Thyrotoxic periodic paralysis (TPP) is caused by an intracellular shift of potassium precipitated by increased levels of thyroid hormones.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    TPP is extremely rare in ethnicities other than Asian descent.

    “It is extremely rare in other ethnicities [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Thyrotoxic periodic paralysis 1 2018 UptoDate 2014 https://www.uptodate.com/contents/thyrotoxic-periodic-paralysis?source=see_link

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    TPP attacks can be precipitated by a large carbohydrate meal, stress, strenuous exercise, alcohol, acute upper respiratory infection, a high-salt diet, menstruation, and cold temperatures.

    “A large carbohydrate meal, stress, strenuous exercise, alcohol, acute upper respiratory infection, a high-salt diet, menstruation, and cold temperatures have been reported to precipitate these attacks [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Thyrotoxic periodic paralysis 1 2018 UptoDate 2014 https://www.uptodate.com/contents/thyrotoxic-periodic-paralysis?source=see_link

      Not checked in the free run.

  • The quote only partly states this claim.

    Interpretationreasoning

    In this patient, a single intramuscular injection of dexamethasone 10 mg precipitated a TPP episode.

    “Based on the clinical presentation of acute onset hypokalemic muscle weakness in a patient with hyperthyroidism after the onset of corticosteroids and a history of a previous similar episode, a diagnosis of TPP episode induced by the injection of dexamethasone was established.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Thyroid hormone (hyperthyroidism) sensitizes adrenergic receptors and stimulates Na+/K+ ATPase channels in skeletal muscle, causing potassium influx into cells.
    • Rests on an assumption: Glucocorticoids increase glucose levels, stimulating insulin release, which shifts potassium intracellularly and accentuates muscle weakness.
    • Rests on an assumption: Corticosteroids increase the number of Na+/K+ ATPase molecules in skeletal muscle.

  • May combine two claims.

    Premisecitation

    Hypokalemia serves as the initial indicator for TPP, with a hyperthyroid hormone profile providing additional support for the diagnosis.

    “The hypokalemia serves as the initial indicator for TPP with hyperthyroid hormone profile providing additional supplementation of the diagnosis [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Thyrotoxic periodic paralysis 1 2018 UptoDate 2014 https://www.uptodate.com/contents/thyrotoxic-periodic-paralysis?source=see_link

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only one of the previously reported patients with steroid-precipitated TPP presented with thyroid storm.

    “Only one of the above patients presented with thyroid storm [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy Hormones (Athens) Tigas S Papachilleos P Ligkros N Andrikoula M Tsatsoulis A 313 316 10 2011 http://www.hormones.gr/745/article/article.html 22281888

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There have been three case reports of prednisone, two of methylprednisolone, and one of hydrocortisone precipitating TPP.

    “There have been three case reports of prednisone [4-6], two of methylprednisolone [7-8], and one of hydrocortisone [9] precipitating TPP.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [4] Thyrotoxic peroidic paralysis in a Hispanic man after the administration of prednisone Endocr Pract Liu Z Braverman LE Malabanan A 427 431 12 2006 16901800

      Not checked in the free run.

    • cites [5] Levothyroxine and prednisone causing generalized weakness in a middle-aged man Case Rep Endocrinol Word A Davidson K Elsayed E 616930 2012 2012 23119192 PMC3483653

      Not checked in the free run.

    • cites [6] Thyrotoxic periodic paralysis (TPP) in a 28-year-old Sudanese man started on prednisone J Am Board Fam Med Tessier JJ Neu SK Horning KK 551 554 23 2010 20616298

      Not checked in the free run.

    • cites [7] Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy Hormones (Athens) Tigas S Papachilleos P Ligkros N Andrikoula M Tsatsoulis A 313 316 10 2011 http://www.hormones.gr/745/article/article.html 22281888

      Not checked in the free run.

    • cites [8] Thyrotoxic periodic paralysis induced by pulse methylprednisolone Intern Med Wongraoprasert S Buranasupkajorn P Sridama V Snabboon T 1431 1433 46 2007 https://www.jstage.jst.go.jp/article/internalmedicine/46/17/46_17_1431/_article 17827844

      Not checked in the free run.

    • cites [9] A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone J Clin Diagn Res Chakrabarti S 271 274 6 2015 PMC4367059 25810683

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    In this case, the pharyngitis (respiratory tract infection) could be considered a co-precipitating factor.

    “In the above case, the pharyngitis (respiratory tract infection) could be considered a co-precipitating factor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A mutation in the Kir 2.6 gene alters muscle membrane excitability, decreasing the ability of muscles to respond to stimulation.

    “A mutation in this gene alters muscle membrane excitability, decreasing the ability of muscles to respond to stimulation and has been found in over a third of the patients with TPP.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis Cell Ryan DP da Silva MRD Soong TW 88 98 140 2010 20074522 PMC2885139

      Not checked in the free run.

24 of 24

  • The paper relies on this without support.

    Thyroid hormone (hyperthyroidism) sensitizes adrenergic receptors and stimulates Na+/K+ ATPase channels in skeletal muscle, causing potassium influx into cells.

    “Hyperthyroidism potentiates catecholamine-mediated Na/K ATPase transport of potassium into the cells.”
    “Thyroid hormone-mediated sensitization of adrenergic receptors leads to stimulation of the Na+/K+ ATPase channels in the skeletal muscles with a resultant influx of potassium into the cells.”

  • The paper relies on this without support.

    Glucocorticoids increase glucose levels, stimulating insulin release, which shifts potassium intracellularly and accentuates muscle weakness.

    “Glucocorticoids increase glucose levels stimulating insulin release, which shifts potassium intracellularly accentuating muscle weakness.”
    “Corticosteroids mediated hyperglycemia can lead to insulin secretion causing an intracellular shift of potassium.”

  • The paper relies on this without support.

    Corticosteroids increase the number of Na+/K+ ATPase molecules in skeletal muscle.

    “Corticosteroids increase the number of Na+/K+ ATPase molecules in the skeletal muscle.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • From the current review of the literature, there are at least 13 cases of TPP associated with glucocorticoid use.

    “From the current review of the literature, there are at least 13 cases of TPP associated with glucocorticoid use [13-16].”

    From Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study (2023) · cites this paper as [13]

  • There are few published cases of glucocorticoid administration prior to TPP.

    “There are few published cases of glucocorticoid administration prior to TPP, thus the possibility that glucocorticoids may precipitate TPP requires further investigation.”

    From Thyrotoxic Periodic Paralysis With Hypokalemia: A Case Study (2023) · cites this paper as [13]

Cites

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Related

Authors
Ahamed, R., McCalley, S., & Sule, A. A.
Affiliations
Trinity Health Oakland Hospital (US)
Corresponding author
Sule, Anupam A
ORCID
Venue
Cureus
Publisher
Springer Science and Business Media LLC
Published
2018-01-23
Volume
10
Issue
1
Pages
e2106-e2106
ISSN
2168-8184 (ISSN-L)
DOI
10.7759/cureus.2106
PMC
PMC5866117
OpenAlex
W2784795251
Cited by
7
References
10
Citations by year
2025: 1 · 2023: 4 · 2022: 1 · 2019: 1
FWCI
0.20
Type
journal article
Language
en
Open access
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 › Surgery › Muscle and Compartmental Disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
Keywords
thyrotoxic periodic paralysis, hyperthyroidism, dexamethasone, hypokalemia, hypophosphatemia, channelopathies, thyroid storm, atenolol, methimazole, medication non-adherence, electrolyte imbalance, Na+/K+-ATPase

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