It has been increasingly reported in the usa due to the rise in the immigrant population. Thyrotoxic periodic paralysis tpp is a medical emergency characterized by an acute and reversible attack of muscle weakness associated with the hypokalemia. Treatment is generally targeted at correcting the thyrotoxic state with careful potassium repletion. Pdf introduction thyrotoxic periodic paralysis tpp is a rare and potentially lethal complication of hyperthyroidism. Thyrotoxic periodic paralysis genetic and rare diseases. The differential diagnosis should include thyrotoxic periodic paralysis see this term which is associated with abnormal thyroid hormone levels.
Thyrotoxic periodic paralysis is a condition in which there are episodes of severe muscle weakness. Thyrotoxic hypokalemic periodic paralysis thpp is a condition that results in transient skeletal muscle paralysis secondary to intracellular potassium sequestration. Thyrotoxic periodic paralysis mayo clinic proceedings. Case report paralysis, thyrotoxic periodic thyrotoxic periodic paralysis we present the case of a 21yearold man who presented to the emergency department with an episode of profound weakness due to thyrotoxic peri odic paralysis, a syndrome of muscular weakness occurring in patients with hyperthyroidism.
Mar 01, 2009 pubmed is a searchable database of medical literature and lists journal articles that discuss thyrotoxic periodic paralysis. Assaying of thyroid function in patients with hypokalemic paralysis distinguishes tpp from other forms of hypokalemic periodic paralysis. This series summarizes the clinical and metabolic features of 10 patients who presented to the western and sunshine hospitals in melbourne, australia, between 1997 and 2002 with thyrotoxic periodic paralysis. Description periodic paralysis disorders are genetic disorders that affect muscle strength. The low 45ca uptake and low atpase activity of the sr of our patient are similar to the findings of au and yeung 1972 during induced paralytic attacks in 4 cases of thyrotoxic periodic paralysis. Hyperkalemic periodic paralysis periodic paralysis ii an ad variant of muscular dystrophy caused by a defective gene on chromosome 17, which encodes the. It is uncommon in other races, although its incidence is. Hyperthyroidism a 10year analysis of thyrotoxic periodic paralysis.
They detected 12 singlenucleotide polymorphisms snps in the cacna1s gene, 3 of which were novel. Thyrotoxic periodic paralysis definition thyrotoxic periodic paralysis is a condition in which there are episodes of severe muscle weakness. Thyrotoxic hypokalemic periodic paralysis in a white man. Proceedings of the second congress of the association of southeast asian nations asean federation of endocrine societies, nov 30 dec 3, bangkok, thailand 1983. Hypokalemia a decreased potassium level in the blood is usually present during attacks. Tpp is a common complication of hyperthyroidism in asian men but is increasingly seen in western countries. Hypokalaemia was identified and treated with resolution of symptoms. The periodic paralyses are a group of rare inherited disorders that cause temporary episodes of muscle weakness or paralysis. Thyrotoxic periodic paralysis tpp is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism overactivity of the thyroid gland. Thyrotoxic periodic paralysis associated with hypokalemia. If you have problems viewing pdf files, download the latest version of adobe reader. Periodic paralysis definition periodic paralysis pp is the name for several rare, inherited muscle disorders marked by temporary weakness, especially following rest, sleep, or exercise.
Also known as hyperthyroid myopathy, tm is one of many myopathies that lead to muscle weakness and muscle tissue breakdown. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal. We report the case of a patient with acute, severe muscle weakness and hypokalemia who was diagnosed in the emergency department to have thyrotoxicosis with acute tpp. Combining clinical and genome information to diagnosis. Assessment of molecular subtypes in thyrotoxic periodic. The patients paralysis resolved upon repletion of his low potassium. Thyrotoxic crisis definition of thyrotoxic crisis by the. Get a printable copy pdf file of the complete article 348k. Thyrotoxic periodic paralysis information mount sinai. Common causes of hypokalemic paralysis include thyrotoxic periodic paralysis tpp which is a disorder most frequently seen in asian males.
Thyrotoxic periodic paralysis tpp, a known condition in asian men, is becoming increasingly common in men from western countries. Thyrotoxic periodic paralysis shihhua lin, md thyrotoxic periodic paralysis tpp, a hyperthyroidismrelated hypokalemia and muscleweakening condition resulting from a sudden shift of potassium into cells, has been seen increasingly in western countries. Oct 21, 2008 hypokalemic periodic paralysis is one form of periodic paralysis, a rare group of disorders that can cause of sudden onset weakness. It occurs in people who have high levels of thyroid hormone in their blood hyperthyroidism, thyrotoxicosis. The underlying hyperthyroidism is often subtle causing difficulty in. The approximate incidence rate for thyrotoxic periodic paralysis in our largely white north american patient population all hyperthyroidism cases ranged from 0. Hla and thyrotoxic periodic paralysis in japanese patients. Hypokalemic periodic paralysis is one form of periodic paralysis, a rare group of disorders that can cause of sudden onset weakness. Thyrotoxic periodic paralysis tpp is a rare compli cation of thyrotoxicosis and is classically associated with attacks of acute muscle weakness, thyrotoxic symptoms and. Burger chang cc, cheng cj, sung cc, chiueh ts, lee ch, chau t, lin sh. Since suspicion for tpp as a differential in diagnosis is of utmost importance to avoid overcorrection of hypokalemia and other complications, we are reporting a case of tpp in a 25yearold caucasian male. Summaries for the public from clinical thyroidology from recent articles in clinical thyroidology table of contents pdf file for saving and printing. Thyrotoxic periodic paralysis tpp is a rare condition characterized by severe muscle weakness and lifethreatening hypokalemia in uncontrolled hyper. Thyrotoxic periodic paralysis tpp is a rare neurological disease characterized by recurrent episodes of paralysis and hypokalemia during a thyrotoxic state.
Thyrotoxic periodic paralysis is a rare endocrine disorder seen predominantly in men of asian origin. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal complication of hyperthyroidism characterized by muscle paralysis and hypokalemia due to a massive intracellular shift of potassium. Thyrotoxic periodic paralysis is a rare cause of acute paralysis in the emergency department ed. One was excluded because their strength was intact. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Thyrotoxic hypokalemic periodic paralysis occurs in approximately 2% of all thyrotoxic patients of asian descent, with a male to female ratio of 20. Additional tests identified the patient as being thyrotoxic. Attacks can last only a few moments or go on for days. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. Periodic paralysis types and treatments musculoskeletal. Thyrotoxic periodic paralysis clinical diagnosis and management. The patient presented with sudden onset paralysis of his extremities. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal complication of hyperthyroidism characterised by muscle paralysis and hypokalaemia.
Mar 21, 2015 thyrotoxic periodic paralysis tpp is a lifethreatening channelopathy manifesting as recurrent episodes of hypokalemia and muscle weakness in the presence of hyperthyroidism. Episodic weakness related to potassium hypokalemic familial thyrotoxic andersen. Insulin resistance in subjects with a history of thyrotoxic periodic paralysis tpp. Normokalemic thyrotoxic periodic paralysis with acute. Hla typing in 35 tpp patients and 263 normal men and women demonstrated highly significant increases p periodic paralysis is a rare autosomal dominant condition with considerable variation in penetrance characterized by episodes of flaccid paralysis with loss of deep tendon reflexes and failure of muscle to respond to electrical stimulation. In addition, we also found a low yield of microsomes. Thyrotoxic periodic paralysis is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism. Thyrotoxic periodic paralysis information mount sinai new. These episodes can last from a few minutes to a few days, depending on. Failure to recognize tpp may lead to improper management. The patients paralysis resolved upon repletion of his low potassium and he was. A mutation in the kcne3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis. May 09, 2017 thyrotoxic periodic paralysis is a rare cause of acute paralysis in the emergency department ed.
Thyrotoxic periodic paralysis may be associated with features of thyroid disease and has been associated with mutations in kir2. This study was, therefore, undertaken to determine hla haplotypes in japanese men with thyrotoxic periodic paralysis tpp. A 10year analysis of thyrotoxic periodic paralysis in 5 patients. Other causes of weakness and paralysis acute intermittent porphyria ascending weakness evaluation. Thyrotoxic periodic paralysis tpp is a condition featuring attacks of muscle. Periodic paralysis definition of periodic paralysis by. Thyrotoxic periodic paralysis is not correlated with the severity of hyperthyroidism and can be seen with all forms of hyperthyroidism albert g. Periodic paralysis is found in all races and in both sexes. Thyrotoxic periodic paralysis definition of thyrotoxic. Thyrotoxic periodic paralysis is not correlated with the.
The patients presentation, hyperthyroidism etiology, precipi. Hypokalemic periodic paralysis hypopp is characterised by episodes of muscle paralysis lasting from a few to 2448 hours and. Laboratory evaluation revealed a markedly low potassium level. Many affected patients do not have obvious symptoms and signs of hyperthyroidism. Some patients have their first attack within minutes of birth, but a few dont have symptoms until they are in their 60s or 70s. Thyrotoxic periodic paralysis tpp is characterized by recurrent episodes of muscle weakness and hypokalemia associated with thyroid hyperactivity. Thpp is a rare complication that sporadically occurs, mostly in young males of asian and latinamerican origin 2,47, and considerably less commonly in caucasians and blacks3,810. Thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia keith c. Periodic paralysis electrolyte disturbance, k, mg, ca hypokalemic periodic paralysis. Click on the link to view a sample search on this topic.
Hypokalemic periodic paralysis hokpp is inherited in an autosomal dominant manner. Twelve patients were found with this icd9 code, but 2 were excluded as they had familial periodic paralysis and no thyrotoxicosis. In each patient, the paralysis resolved on return of euthyroidism. Thyrotoxic periodic paralysis treatment consists of controlling thyrotoxicosis and betablocking agents. Tpp is typically present in young asian men, female, and. Pdf thyrotoxic hypokalemic periodic paralysis tpp is a condition characterized by the triad of acute hypokalemia without total body potassium. The associations are not only found in caucasian population mainly brazilian, but also in singaporean. Periodic paralysis pp is a muscle disease in the family of diseases called channelopathies, manifested by episodes of painless muscle weakness.
Hello everyone, as some of you might have read some of my posts here and elsewhere, im trying to revive a community actually, i think a subreddit is the most appropriate form for this to discuss medical applications of the ketogenic diet with a focus on neurological disorders epilepsy, periodic paralysis, hypokalemic sensory overload, depression, anxiety, schizophrenia, and the like. Thyrotoxic periodic paralysis is clinically similar to hereditary hypokalemic periodic paralysis hokpp. Thyrotoxic periodic paralysis tpp is a complication of hyperthyroidism mainly reported in asian males. Periodic paralysis occurs in ats independent of blood potassium concentration, but periodic paralysis in tpp can occur only in the presence of hypokalemia and thyrotoxic state.
Reported predominantly among individuals of asian descent, tpp is a rare manifestation of. Thyrotoxic periodic paralysis penn state hershey medical. Both rs623011 and rs312691 polymorphism are located at the 17q24. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Familial periodic paralysis msd manual professional edition. Susceptible individuals often have an underlying channelopathy, which may be exacerbated by lifestyle factors or underlying medical comorbidities such as hyperthyroidism. Potassium supplementation, dichlorphenamide, propranolol, and spironolactone may be helpful during the attacks as well as for prophylaxis. This series summarizes the clinical and metabolic features of 10 patients who presented to the western and sunshine hospitals in melbourne, australia, between 1997 and 2002 with thyrotoxic periodic paralysis tpp. Case of thyrotoxic periodic paralysis in a caucasian male and. Thyrotoxic periodic paralysis tpp is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia.
Tassone h, moulin a, henderson so 2004 the pitfalls of potassium replacement in thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis clinical diagnosis and. There are two major forms, hypokalemic and hyperkalemic, each caused by. Thyrotoxic periodic paralysis terminated with intravenous. The condition has been linked with genetic mutations in genes that code for certain ion channels that transport electro. Several types of periodic paralysis there are various different types of periodic paralysis butthe most commonly occurring ones include the andersentawil syndrome, thyrotoxic periodic paralysis, paramyotonia congenital, hypokalemic periodicparalysis and hyperkalemic periodic paralysis.
The case is reported of a patient who presented to the accident and emergency department with sudden onset of weakness of his lower limbs. The disorder is generally thought to be due to acute hypokalemia leading to paralysis. Familial periodic paralysis is a rare autosomal dominant condition with considerable variation in penetrance characterized by episodes of flaccid paralysis with loss of deep tendon reflexes and failure of muscle to respond to electrical stimulation. Hypokalemic periodic paralysis is a rare and dramatic complication of hyperthyroidism.
Thyrotoxic periodic paralysis tpp is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. The condition may be lifethreatening if weakness of the breathing muscles leads to respiratory failure, or if the low potassium levels lead to cardiac arrhythmias. Thyrotoxic periodic paralysis tpp, a disorder most commonly seen in asian men, is characterized by abrupt onset of hypokalemia and paralysis. A range of conditions of varying genetic origin and symptomotology, clinically associated with blood potassium levels. It is often not recognised when first seen because of lack of familiarity with the disorder and partly due to the subtleness of thyrotoxicosis. Get a printable copy pdf file of the complete article 348k, or click on a page image below to browse page by page. Hypokalemic periodic paralysis genetic and rare diseases. Thyrotoxic periodic paralysis british journal of medical. Periodicparalysis differential diagnosis and important. Thyrotoxic myopathy tm is a neuromuscular disorder that develops due to the overproduction of the thyroid hormone thyroxine. Primary periodic paralysis ppp is a group of rare diseases that temporarily make muscles stiff, weak, or unable to move. The symptoms of periodic paralysis can also be caused by hyperthyroidism, and are then labeled thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis tpp is an uncommon syndrome that can be fatal.
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