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thyrotoxic hypokalemic periodic paralysis
Etiology:
- can occur in association with any cause of hyperthyroidism, but is most commonly associated with Graves disease
Epidemiology:
- occurs in Mexican or Asian men
Pathology:
- hyperthyroidsm
- muscle disorder
Genetics:
- sporadic
- associated with defects in KCNJ18
- associated with defects in KCNE3 (type 1)
Clinical manifestations:
- recurrent episodes of acute muscular weakness of all four extremities, varying in severity from paresis to complete paralysis
- attacks are triggered by ingestion of a high carbohydrateload or strenuous physical activity followed by a period of rest
- palpitations, trembling, insomnia [5] (case report)*
- goiter may be present [5]
- thyrotoxicosis
* image & videos [5]
Laboratory:
- serum K+: hypokalemia during a thyrotoxic state
- thyroid function tests: evidence of hyperthyroidism
a) low serum TSH
b) high serum T4 & free T4, high free T3
- serum phosphate may be low [5]
Differential diagnosis:
- similar to hereditary hypokalemic periodic paralysis, except that hyperthyroidism is an absolute requirement
Management:
- resolves with treatment of hyperthyroidism [4]
General
periodic paralysis; hypokalemic periodic paralysis; Andersen-Tawil Syndrome
hyperthyroidism
Database Correlations
OMIM correlations
References
- OMIM :accession 188580
- OMIM :accession 613239
- Falhammar H, Thoren M, Calissendorff J.
Thyrotoxic periodic paralysis: clinical and molecular aspects.
Endocrine. 2013 Apr;43(2):274-84. Review.
PMID: 22918841
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Fralick M, Sarma S.
Images in Clinical Medicine
Thyrotoxic Periodic Paralysis.
N Engl J Med 2021. May 8
PMID: 33983691
https://www.nejm.org/doi/full/10.1056/NEJMicm2030770