{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T10:46:01Z","timestamp":1773139561439,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T00:00:00Z","timestamp":1589760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Despite its\u2019 life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series of three cases of TPP as first presentation of Graves\u2019 disease in a young Caucasian male and in two Caucasian elderly and middle-aged women, respectively. The first patient developed malignant ventricular arrhythmias due to severe hypokalemia and was defibrillated, with recovery after prompt potassium correction and administration of antithyroid agents and propranolol. The other two cases developed persistent hypokalemia despite adequate potassium chloride (KCl) repletion, with slow recovery of motor deficit and serum potassium normalization up to day 5. In the first case, long-term euthyroid state was achieved via total thyroidectomy due to the presence of a suspicious nodule that proved to be malignant. In the other two cases, medical treatment was the choice of therapy for thyrotoxicosis. None experienced recurrent TPP. Thyroid hormone evaluation is mandatory in the presence of hypokalemic paralysis, even in the absence of clinical signs of thyrotoxicosis. If TPP is confirmed, initial therapy should comprise antithyroid drugs and propranolol, besides hypokalemia correction.<\/jats:p>","DOI":"10.3390\/diagnostics10050316","type":"journal-article","created":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T02:43:42Z","timestamp":1589769822000},"page":"316","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Thyrotoxic Periodic Paralysis\u2014A Misleading Challenge in the Emergency Department"],"prefix":"10.3390","volume":"10","author":[{"given":"Stefana","family":"Bilha","sequence":"first","affiliation":[{"name":"Endocrinology Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-8565","authenticated-orcid":false,"given":"Ovidiu","family":"Mitu","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Teodoriu","sequence":"additional","affiliation":[{"name":"Endocrinology Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Haba","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Preda","sequence":"additional","affiliation":[{"name":"Endocrinology Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1530\/EJE-13-0381","article-title":"A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: Focus on symptomatology and precipitants","volume":"169","author":"Chang","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_2","first-page":"OC17-9","article-title":"Hypokalaemic Periodic Paralysis- A Prospective Study of the Underlying Etiologies","volume":"9","author":"Jandhyala","year":"2015","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"314262","DOI":"10.1155\/2014\/314262","article-title":"Case Report Case of Thyrotoxic Periodic Paralysis in a Caucasian Male and Review of Literature","volume":"2014","author":"Thethi","year":"2014","journal-title":"Case Rep. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1530\/EJE-09-0553","article-title":"Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years","volume":"161","author":"Shiang","year":"2009","journal-title":"Eur. J. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"649502","DOI":"10.1155\/2014\/649502","article-title":"Thyrotoxic periodic paralysis: Clinical challenges","volume":"2014","author":"Vijayakumar","year":"2014","journal-title":"J. Thyroid Res."},{"key":"ref_6","unstructured":"Amin, M.B., Edge, S.B., Greene, F.L., Byrd, D.R., Brookland, R.K., Washington, M.K., Gershenwald, J.E., Compton, C.C., Hess, K.R., and Sullivan, D.C. (2017). AJCC Cancer Staging Manual, Springer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"133","DOI":"10.6065\/apem.2019.24.2.133","article-title":"Thyrotoxic hypokalemic periodic paralysis due to Graves\u2019 disease in 2 adolescents","volume":"24","author":"Roh","year":"2019","journal-title":"Ann. Pediatr. Endocrinol. Metab."},{"key":"ref_8","first-page":"274","article-title":"Thyrotoxic periodic paralysis: Clinical and molecular aspects","volume":"43","author":"Falhammar","year":"2013","journal-title":"Endocrine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7174","DOI":"10.19082\/7174","article-title":"Thyrotoxic periodic paralysis: Case report and review of the literature","volume":"10","author":"Gunturu","year":"2018","journal-title":"Electron. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4103\/IJCIIS.IJCIIS_39_17","article-title":"A rare case of hypokalemic ventricular tachycardia in a patient with thyrotoxic periodic paralysis","volume":"9","author":"Ghalyoun","year":"2019","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00000441-200309000-00004","article-title":"Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis","volume":"326","author":"Hsu","year":"2003","journal-title":"Am. J. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jelectrocard.2019.04.001","article-title":"Thyrotoxic periodic paralysis with ventricular tachycardia","volume":"54","author":"Tsai","year":"2019","journal-title":"J. Electrocardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/j.1472-8206.2010.00835.x","article-title":"Mechanisms of hypokalemia-induced ventricular arrhythmogenicity","volume":"24","author":"Osadchii","year":"2010","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/20009666.2017.1316906","article-title":"Thyrotoxic periodic paralysis: A case study and review of the literature","volume":"7","author":"Meseeha","year":"2017","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_15","unstructured":"Adam, M.P., Ardinger, H.H., Pagon, R.A., and Wallace, S.E. (2020, May 14). Hypokalemic periodic paralysis, GeneReviews\u00ae [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK1338\/."},{"key":"ref_16","first-page":"126","article-title":"Thyrotoxic Periodic Paralysis","volume":"19","author":"Haider","year":"2019","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.braindev.2018.05.011","article-title":"Successful treatment of normokalemic periodic paralysis with hydrochlorothiazide","volume":"40","author":"Akaba","year":"2018","journal-title":"Brain Dev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tristani-Firouzi, M. (2018). Andersen-Tawil Syndrome. Cardiac Electrophysiology: From Cell to Bedside: Seventh Edition, Elsevier.","DOI":"10.1016\/B978-0-323-44733-1.00094-8"},{"key":"ref_19","first-page":"9763452","article-title":"Graves\u2019 Disease Presenting with Periodic Paralysis to the Emergency Department","volume":"2018","author":"Lan","year":"2018","journal-title":"Case Rep. Endocrinol."},{"key":"ref_20","first-page":"32","article-title":"Glucocorticoid Induced Hypokalemic Periodic Paralysis in Subclinical Hyperthyroidism: Case Report","volume":"3","author":"Genek","year":"2016","journal-title":"Mu\u011fla S\u0131tk\u0131 Ko\u00e7man \u00dcniversitesi T\u0131p Dergisi"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1477-7819-10-21","article-title":"Surgical treatment for thyrotoxic hypokalemic periodic paralysis: Case report","volume":"10","author":"Lin","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1111\/j.1468-1331.2008.02132.x","article-title":"Hypokalemic thyrotoxic periodic paralysis: Clinical characteristics and predictors of recurrent paralytic attacks","volume":"15","author":"Hsieh","year":"2008","journal-title":"Eur. J. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jemermed.2011.05.090","article-title":"Complete heart block during potassium therapy in thyrotoxic periodic paralysis","volume":"44","author":"Wang","year":"2013","journal-title":"J. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e182","DOI":"10.4158\/EP14304.CR","article-title":"Thyrotoxic periodic paralysis: A review of cases in the last decade","volume":"1","author":"Hosein","year":"2015","journal-title":"AACE Clin. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1053\/ajkd.2001.22090","article-title":"Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis","volume":"37","author":"Lin","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/08998280.2006.11928143","article-title":"Thyrotoxic Periodic Paralysis","volume":"19","author":"Lam","year":"2006","journal-title":"Baylor Univ. Med. Cent. Proc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"428","DOI":"10.5144\/0256-4947.2005.428","article-title":"Unusual presentations of differentiated thyroid cancer: Analysis of 55 cases from North India","volume":"25","author":"Bhansali","year":"2005","journal-title":"Ann. Saudi Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1507\/endocrj.47.191","article-title":"Hyperthyroid Graves\u2019 disease after hemithyroidectomy for papillary carcinoma: Report of three cases","volume":"47","author":"Misaki","year":"2000","journal-title":"Endocr. J."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/5\/316\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:29:45Z","timestamp":1760174985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/5\/316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,18]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["diagnostics10050316"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics10050316","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,18]]}}}