Thyrotoxic periodic paralysis: diagnostic and management considerations

Area of Science:

• Endocrinology
• Neurology
• Internal Medicine

Background:

• Thyrotoxic periodic paralysis (TPP) is a rare, potentially life-threatening complication of thyrotoxicosis.
• It is characterized by hypokalemia-induced flaccid paralysis due to intracellular potassium shift.

Purpose of the Study:

• To report a case of TPP in a middle-aged male of Filipino origin.
• To highlight the diagnostic features and management of TPP.

Main Methods:

• A case report detailing patient presentation, clinical findings, and laboratory results.
• Management involved intravenous potassium chloride, propranolol, and methimazole.

Main Results:

• The patient presented with acute bilateral lower-limb weakness and severe hypokalemia (1.7 mmol/L).
• ECG showed sinus tachycardia, AV block, and U-waves. Thyroid panel revealed suppressed TSH with elevated FT4/FT3.
• Muscle strength normalized within 24 hours following treatment.

Conclusions:

• TPP diagnosis is supported by hypokalemia without acid-base disorder, appropriate renal potassium conservation, and characteristic ECG changes.
• Effective management requires prompt potassium repletion, beta-blockade, and definitive treatment of thyrotoxicosis to prevent recurrence.