In Thyrotoxicosis there is
(B) Hypokalemic Periodic Paralysis> Acute generalized weakness due to thyrotoxic periodic paralysis# Thyrotoxic periodic paralysis (TPP) is a disorder characterized by thyrotoxicosis, hypokalemia and predominantly proximal lower limb paralysis. Despite the female predominance of hyperthyroidism, TPP occurs most frequently in males in a ratio of 20:1, and 90% of patients are of Asian descent> Prodromal symptoms may consist of muscle stiffness or cramping. Sensation, as well as bulbar and respiratory muscle strength, remains intact.> Reflexes may be decreased or absent.> Attacks may be precipitated by a high carbohydrate meal (secondary to insulin secretion) or physical exertion.> In one series, 84% of attacks occurred between 1 and 6 am. Episodes are acute in onset and last 1-96 hours. As in this patient, symptoms and signs of hyperthyroidism may be subtle at initial presentation.> Electrocardiographic findings such as ST-segment depression with T-wave flattening and the presence of U waves are typical of hypokalemia. Findings supportive of a diagnosis of TPP are sinus tachycardia, elevated QRS voltage and first-degree AV block.> Pump sensitivity to adrenergic stimulation may be higher in patients with TPP than in those with hyperthyroidism alone, resulting in intracellular potassium shift and subsequent hypokalemia.
Hyperkalemic Periodic Paralysis
Hypokalemic Periodic Paralysis
Normokalemic Periodic Paralysis
No Periodic Paralysis
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