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. Factors like highcarbohydrate meal exercise, steroid, and stress can. If the inline pdf is not rendering correctly, you can download the pdf file here. Thyrotoxic periodic paralysis penn state hershey medical center. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. If you have problems viewing pdf files, download the latest version of adobe reader. Mar 02, 2016 hyperthyroid periodic paralysis hpp is a rare life threatening complication of hyperthyroidism commonly occurring in young asian males but sporadically found in other races. Thyrotoxic periodic paralysis and polymorphisms of the ar. Thyrotoxic periodic paralysis british journal of medical.
Hypokalemic periodic paralysis hokpp is inherited in an autosomal dominant manner. Many affected patients do not have obvious symptoms and signs of hyperthyroidism. The condition has been linked with genetic mutations in genes that code for certain ion channels that transport electro. Outline causes of primary periodic paralysis causes of secondary periodic paralysis presentation of hyperkalemic pp comparison between hyper pp vs hypo pp. Detects mutations in 3 genes that cause severe episodes of muscle weakness. It usually presents as sudden profound muscle weakness manifested as almost complete immobility and can affect proximal and distal limb muscles, respiratory musculature as well as the cardiac conduction system. Failure to recognize tpp may lead to improper management. Exercise test could be one of the diagnostic tools in the interattack state of the probable cases with thyrotoxic periodic paralysis. The presentation is most commonly seen in asian men and is usually associated with hypokalemia, which is believed to play a role in the underlying pathophysiology. Tpp is a common complication of hyperthyroidism in asian men but is increasingly seen in western countries. It has been increasingly reported in the usa due to the rise in the immigrant population. Pdf thyrotoxic periodic paralysis tpp, a disorder most commonly seen in asian men, is characterized by abrupt onset of hypokalemia and.
Exercise test in the interattack period of thyrotoxic. Thyrotoxic periodic paralysis may be associated with features of thyroid disease and has been associated with mutations in kir2. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal complication of hyperthyroidism characterised by muscle paralysis and hypokalaemia. Familial periodic paralysis msd manual professional edition. Thyrotoxic periodic paralysis clinical diagnosis and management. Summaries for the public from clinical thyroidology from recent articles in clinical thyroidology table of contents pdf file for saving and printing.
However, the case number of this study is small and largerscale studies. Epidemiology hypokalemic pp is the most common of the periodic paralyses, but is still quite rare, with an estimated prevalence of 1 in 100,000 1. They detected 12 singlenucleotide polymorphisms snps in the cacna1s gene, 3 of which were novel. 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.
The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. Periodic paralysis electrolyte disturbance, k, mg, ca hypokalemic periodic paralysis. Normokalemic thyrotoxic periodic paralysis with acute. Insulin resistance in subjects with a history of thyrotoxic periodic paralysis tpp.
Pdf thyrotoxic periodic paralysis is an uncommon disorder characterized by hypokalaemia, thyrotoxicosis and paralysis, most commonly. Clinical challenges abhishekvijayakumar, 1,2 giridharashwath, 1 anddurgannathimmappa 1 department of general surgery, victoria hospital, bangalore medical college and research institute, bangalore, india. Combining clinical and genome information to improve diagnosis how diagnosis is getting easier update on the lidocaine. Thyrotoxic periodic paralysis tpp, a disorder most commonly seen in asian men, is characterized by abrupt onset of hypokalemia and 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. Tawil normokalemic hyperkalemic familial with paramyotonia congenita andersen. 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. Comparison of thyrotoxic periodic paralysis with idiopathic hypokalemic periodic paralysis the demographic and clinical variables such as precipitating factors, presence of myalgia, number of attacks and severity of weakness were not statistically different between the two groups. Hypokalaemia was identified and treated with resolution of symptoms. Thyrotoxic periodic paralysis tpp is a rare disease entity highlighted by hypokalemia, flaccid paralysis, and thyrotoxicosis. It is characterised by hypokalemia and acute onset paraparesis with prevalence of one in one hundred thousand 1 in 00. Attacks can last only a few moments or go on for days. 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 an uncommon disorder characterised by.
Mar 01, 2009 pubmed is a searchable database of medical literature and lists journal articles that discuss thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis information mount sinai. Episodic weakness related to potassium hypokalemic familial thyrotoxic andersen. Periodicparalysis differential diagnosis and important. Thyrotoxic periodic paralysis clinical diagnosis and. Thyrotoxic periodic paralysis genetic and rare diseases. These episodes can last from a few minutes to a few days, depending on. Thyrotoxic periodic paralysis tpp is an uncommon syndrome that can be fatal.
The clinical and genetic features in a cohort of mainland chinese. Thyrotoxic periodic paralysis tpp is a neuromuscular disorder that, in a global perspective, only affects a small percentage of patients with thyrotoxicosis of any aetiology, but is a fairly. Periodic paralysis complicating thyrotoxicosis in chinese. Thyrotoxic periodic paralysis tpp is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. Thyrotoxic periodic paralysis information mount sinai new.
Thyrotoxic periodic paralysis treatment consists of controlling thyrotoxicosis and betablocking agents. A 29yearold asian male with a oneyear history of recurrent generalized muscle weakness presented to the emergency department with whole body paralysis. Additional tests identified the patient as being thyrotoxic. Both rs623011 and rs312691 polymorphism are located at the 17q24. The underlying hyperthyroidism is often subtle causing difficulty in.
Comparative study of thyrotoxic periodic paralysis from. Primary periodic paralysis ppp is a group of rare diseases that temporarily make muscles stiff, weak, or unable to move. Thyrotoxic periodic paralysis tpp is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism overactivity of the thyroid gland. Hypokalemic periodic paralysis is a rare and dramatic complication of hyperthyroidism. 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. This condition mainly affects male patients of asian descent.
The spectrum of muscle weakness to paralysis induced by hypokalemia is called hypokalemic paralysis hp, and the. 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. Early morning weakness and paralysis with hypokalaemia should suggest thyrotoxic periodic paralysis to the emergency physician caring for asian patients. The patients symptoms began abruptly that morning, when he was unable to stand and exit a train. Jun 12, 2017 hypokalemic periodic paralysis hokpp is characterized by episodes of muscle paralysis associated with a fall in blood potassium levels hypokalemia. Paroxysmal hypokalemic weakness, thyrotoxic periodic paralysis. Other causes of weakness and paralysis acute intermittent porphyria ascending weakness evaluation. The approximate incidence rate for thyrotoxic periodic paralysis in our largely white north american patient population all hyperthyroidism cases ranged from 0. Thyrotoxic periodic paralysis and polymorphisms of the adrb2, ar, and gabra3 genes in men with graves disease suyeon park 1, tae yong kim, soyoung sim 2, seonhee lim 2, mijin kim. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. It is important for physicians to distinguish tpp from familial hypokalemic periodic paralysis, a more common cause of periodic paralysis in caucasians. Thyrotoxic periodic paralysis admitted to the medical. Hypokalemia a decreased potassium level in the blood is usually present during attacks.
Episodes typically involve a temporary inability to move muscles in the arms and legs. Thyrotoxic periodic paralysis in a patient abusing thyroxine for weight reduction. 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. Combining clinical and genome information to diagnosis. Thyrotoxic periodic paralysis tpp is a condition featuring attacks of muscle. The patients paralysis resolved upon repletion of his low potassium. An expert roundtable on primary periodic paralysis ppp was sponsored by strongbridge biopharma plc in january 2019. The case is reported of a patient who presented to the accident and emergency department with sudden onset of weakness of his lower limbs. Thyrotoxic periodic paralysis tpp is more commonly reported in oriental asians. The periodic paralyses are a group of rare inherited disorders that cause temporary episodes of muscle weakness or paralysis. Hypokalemic periodic paralysis genetic and rare diseases. Potassium supplementation, dichlorphenamide, propranolol, and spironolactone may be helpful during the attacks as well as for prophylaxis.
Pdf acute hypokalemic paralysis is a rare cause of acute weakness. Among the hypopp, familial hypokalemic periodic paralysis fpp is the most common cause in western countries, and. Case of thyrotoxic periodic paralysis in a caucasian male and. Hyperthyroidism a 10year analysis of thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis associated with hypokalemia. Thyrotoxic periodic paralysis tpp is characterized by recurrent episodes of muscle weakness and hypokalemia associated with thyroid hyperactivity. Clinical and metabolic features of thyrotoxic periodic paralysis in. In addition, we also found a low yield of microsomes. Common causes of hypokalemic paralysis include thyrotoxic periodic paralysis tpp which is a disorder most frequently seen in asian males. It occurs in people who have high levels of thyroid hormone in their blood hyperthyroidism, thyrotoxicosis. Thyrotoxic periodic paralysis tpp is a medical emergency characterized by an acute and reversible attack of muscle weakness associated with the hypokalemia. Thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia keith c. Periodic paralysis is found in all races and in both sexes. See hyperkalemic periodic paralysis and thyrotoxic periodic paralysis.
Morbidity and mortality associated with unrecognized disease can occur. Severe episodes of muscle weakness, often triggered by abnormally high or low potassium levels hyperkalemic and hypokalemic periodic paralysis, or high thyroid levels thyrotoxic. 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. Thyrotoxic periodic paralysis is clinically similar to hereditary hypokalemic periodic paralysis hokpp. In each patient, the paralysis resolved on return of euthyroidism. Periodic paralysis pp is a muscle disease in the family of diseases called channelopathies, manifested by episodes of painless muscle weakness. Periodic paralysis comprises a group of neuromuscular diseases in which the patients. Thyrotoxic periodic paralysis tpp is a rare complication of thyrotoxicosis and is classically associated with attacks of acute muscle weakness, thyrotoxic symptoms and hypokalemia 1,2. Click on the link to view a sample search on this topic.
The differential diagnosis should include thyrotoxic periodic paralysis see this term which is associated with abnormal thyroid hormone levels. Thyrotoxic periodic paralysis definition thyrotoxic periodic paralysis is a condition in which there are episodes of severe muscle weakness. A mutation in the kcne3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis. The definitive treatment is to render the patient euthyroid. Thyrotoxic periodic paralysis is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism. Hypokalemic periodic paralysis hypopp is characterised by episodes of muscle paralysis lasting from a few to 2448 hours and. Among the hypopp, familial hypokalemic periodic paralysis fpp is the most common cause in western countries, and thyrotoxic periodic paralysis tpp. Laboratory evaluation revealed a markedly low potassium level.
These episodes may be precipitated by heavy exercise, fasting, or highcarbohydrate meals. Thyrotoxic periodic paralysis is a condition in which there are episodes of severe muscle weakness. 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. The associations allocation for research on hyperkalemic and hypokalemic periodic paralysis. Thyrotoxic periodic paralysis tpp is a lifethreatening. Table of contents pdf file for saving and printing.
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. Thyrotoxic periodic paralysis tpp is an alarming and potentially lethal. It is often not recognised when first seen because of lack of familiarity with the disorder and partly due to the subtleness of thyrotoxicosis. Tpp has been reported more frequently in asian males than in patients with other ancestral origins 14. Thyrotoxic periodic paralysis tpp is a rare compli cation of thyrotoxicosis and is classically associated with attacks of acute muscle weakness, thyrotoxic symptoms and. Thyrotoxic periodic paralysis penn state hershey medical. Reported predominantly among individuals of asian descent, tpp is a rare manifestation of. 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, a hyperthyroidismrelated hypokalemia and muscleweakening condition resulting from a sudden shift of potassium into cells, has been seen increasingly in. The patient presented with sudden onset paralysis of his extremities.
Thyrotoxic periodic paralysis occurs when the thyroid gland pdf to word online converter freeware releases excessive amounts of thyroxine thyroid hormone. Thyrotoxic periodic paralysis tpp is a rare neurological disease characterized by recurrent episodes of paralysis and hypokalemia during a thyrotoxic state. Thyrotoxic periodic paralysis in the united states. Thyrotoxic periodic paralysis terminated with intravenous. Thyrotoxic periodic paralysis tpp is a lesser known cause of intermittent, potentially curable, muscle weakness. The patients paralysis resolved upon repletion of his low potassium and he was. Thyrotoxic periodic paralysis tpp, a known condition in asian men, is becoming increasingly common in men from western countries. The meeting brought together a group of expert clinicians and researchers specializing in neuromuscular disorders, representing a variety of academic institutions and teaching hospitals across the nation. The thyroid gland in relation to neuromuscular disease. Periodic paralysis types and treatments musculoskeletal. A 10year analysis of thyrotoxic periodic paralysis in 5 patients. It can be the first manifestation of thyrotoxicosis in male patients who are otherwise asymptomatic. Thyrotoxic periodic paralysis is a rare endocrine disorder seen predominantly in men of asian origin. Oct 21, 2008 hypokalemic periodic paralysis is one form of periodic paralysis, a rare group of disorders that can cause of sudden onset weakness.
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