Thyrotoxic periodic paralysis

Background

• Periodic paralysis occurs from hypokalemia, hyperkalemia, and hyperthyroidism
• More common in males
• More common in Asians
• A variant of hypokalemic periodic paralysis

Clinical Features

• Painless weakness especially after exercise or diet changes
• Lasting hours to days
• Most common from 20-40 years old
• Physical Exam
  • Proximal>Distal muscle weakness
  • Hyporeflexia or areflexia

Differential Diagnosis

• Other periodic paralysis'
• Guillain-Barre Syndrome
• Myasthenia Gravis
• Botulism
• Tick Paralysis
• Transverse Myelitis

Diagnosis

• Hypokalemia
• Thyrotoxicosis
• EMG

Management

• Replete potassium
• Replete magnesium if concomitant hypomag
• EKG (looking for hypokalemic findings)

Disposition

• Telemetry admission
• Endocrine consult