Thyrotoxic

A case study

Originally published in Lifeline; Newsletter of The California Chapter of the American College of Emergency Physicians Christopher Fee, MD and Susan B. Promes, MD FACEP Alameda County California Medical Center, Highland General Hospital

Pain Often Overlooked

Pain is an often overlooked component of the periodic paralyses. Patients who report muscle pain in association with their episodes are too often told that the periodic paralyses are not painful despite many authoritative reports to the contrary. In fact the pain which accompanies the periodic paralyses is described in some of the literature as prominent or constant.

What happens during an attack of Periodic Paralysis?

People with Periodic Paralysis (PP) have episodes in which their muscles become weak or paralyzed in response to variations in the amount of potassium in their blood. These variations occur during sleep, they may result from food the person has eaten, from a sudden change in a person's activity level, from rest after activity, emotional stress, from becoming chilled, or a number of other factors. Potassium levels vary all the time.

What is Thyrotoxic Hypokalemic Periodic Paralysis?

Thyrotoxic Hyperkalemic Periodic Paralysis (TPP) is an uncommon disorder with three characteristics which occur at the same time:  

1. too much thyroid hormone

2. low levels of potassium in the blood (hypokalemia)

3. muscle weakness or paralysis 

The periodic paralyses are a group of rare inherited disorders that cause temporary episodes of muscle weakness or paralysis. Periodic Paralysis is found in all races and in both sexes. Some patients have their first attack within minutes of birth, but a few don't have symptoms until they are in their 60’s or 70’s. Attacks can last only a few moments or go on for days, depending on the type of periodic paralysis the person has. Some forms of periodic paralysis include muscle stiffness or rigidity as part of the attacks.