{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:55:16Z","timestamp":1782222916586,"version":"3.54.5"},"reference-count":18,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,13]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>A Caucasian man in his 20s with no known medical history presented to the emergency department with acute flaccid quadriparesis following a high-carbohydrate meal and strenuous physical activity. Initial evaluation revealed profound hypokalaemia (1.7 mmol\/L; reference 3.5\u20135 mmol\/L), marked QTc prolongation (594 ms), and mild troponin I elevation (51 ng\/L; reference &lt;40 ng\/L). He reported two similar episodes over the preceding year that had been attributed to dehydration. Thyroid function testing demonstrated severe hyperthyroidism with suppressed thyroid-stimulating hormone (&lt;0.003 mIU\/L; reference 0.4\u20134 mIU\/L), with positive thyroid-stimulating immunoglobulin confirming Graves\u2019 disease as the underlying cause. Thyrotoxic periodic paralysis (TPP) was diagnosed. Treatment included cautious potassium replacement, propranolol and antithyroid therapy. Paralysis resolved completely within 24 hours without rebound hyperkalaemia. He remained clinically well without recurrence after achieving euthyroid state. This case highlights the importance of recognising TPP in individuals of any ethnic background and emphasises key management principles to prevent serious complications.<\/jats:p>","DOI":"10.1136\/bcr-2026-272286","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:35:41Z","timestamp":1782221741000},"page":"e272286","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Thyrotoxic periodic paralysis presenting with severe hypokalaemia and cardiac involvement"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2192-6734","authenticated-orcid":false,"given":"Darpan","family":"Kothia","sequence":"first","affiliation":[{"name":"Internal Medicine, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otto","family":"Valdes","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asaad","family":"Mouselli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4581-3713","authenticated-orcid":false,"given":"Bola F","family":"Habeb","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"2026062306351672000_19.6.e272286.1","doi-asserted-by":"publisher","DOI":"10.4065\/80.1.99"},{"key":"2026062306351672000_19.6.e272286.2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jemermed.2022.10.023","article-title":"Thyrotoxic Periodic Paralysis: An Under-Recognized Cause of Paralysis in Young Hispanic Men","volume":"64","author":"Gulde","year":"2023","journal-title":"J Emerg Med"},{"key":"2026062306351672000_19.6.e272286.3","doi-asserted-by":"crossref","DOI":"10.1530\/ETJ-25-0220","article-title":"Twenty-year trend of thyrotoxicosis and thyrotoxic periodic paralysis: a population-based cohort study","volume":"14","author":"Li","year":"2025","journal-title":"Eur Thyroid J"},{"key":"2026062306351672000_19.6.e272286.4","first-page":"274","article-title":"Thyrotoxic periodic paralysis: clinical and molecular aspects","volume":"43","author":"Falhammar","year":"2013","journal-title":"Endocrine"},{"key":"2026062306351672000_19.6.e272286.5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0381"},{"key":"2026062306351672000_19.6.e272286.6","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012010046"},{"key":"2026062306351672000_19.6.e272286.7","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jemermed.2012.11.107","article-title":"Thyrotoxic periodic paralysis: correct hypokalemia with caution","volume":"45","author":"Cope","year":"2013","journal-title":"J Emerg Med"},{"key":"2026062306351672000_19.6.e272286.8","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(23)00005-0"},{"key":"2026062306351672000_19.6.e272286.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00339-1"},{"key":"2026062306351672000_19.6.e272286.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1602678"},{"key":"2026062306351672000_19.6.e272286.11","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26009"},{"key":"2026062306351672000_19.6.e272286.12","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12831"},{"key":"2026062306351672000_19.6.e272286.13","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1097\/01.CCM.0000242249.10856.49","article-title":"Early diagnosis of thyrotoxic periodic paralysis: spot urine calcium to phosphate ratio","volume":"34","author":"Lin","year":"2006","journal-title":"Crit Care Med"},{"key":"2026062306351672000_19.6.e272286.14","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2001.22090"},{"key":"2026062306351672000_19.6.e272286.15","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1177\/0004563218785395","article-title":"Does thyrotoxic periodic paralysis have a genetic predisposition? 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