Abstract
Thyrotoxic periodic paralysis is a sporadic entity characterized by hypokalemia and paralysis in the setting of hyperthyroidism. TPP is most commonly described in young Asian males. Studies have shown an association with mutations affecting inward rectifying potassium channels. The pathophysiology involves Na+-K+- ATPase channel causing an increased intracellular shift of potassium ions in the hyperthyroid state and in the presence of another precipitating condition. Most cases of thyrotoxic periodic paralysis are defined in young Asian males of 20–40 years of age, here we present an interesting case of thyrotoxic periodic paralysis in 32-year-old African American male, who presented with sudden onset weakness in the bilateral lower extremity and left upper extremity. Interestingly, the patient also has sensory deficits, a feature not known to be associated with thyrotoxic periodic paralysis.
Highlights
Thyrotoxic periodic paralysis is a sporadic entity that only occurs in association with thyrotoxicosis
While most cases of TPP are described in young Asian males [1,2,5,8], in this report we present a very interesting case of TPP in a young 32-year-old African American male
The pathophysiology involves upregulation of Na-K ATPase leading to an increased intracellular shift of potassium ions in hyperthyroid state and most often in the presence of another precipitant [1,2,5,6,7,8,9]
Summary
Thyrotoxic periodic paralysis is a sporadic entity that only occurs in association with thyrotoxicosis. 10 out of 30 Caucasians or Brazilian patients with TPP had a mutation in gene encoding KCNJ18 (kir2.6), an inward rectifying potassium channel expressed in skeletal muscle [2,3]. Similar mutations have been found in another study in the patient population from Singapore with TPP [3] Another novel gene is identified in population from Taiwan negatively regulating KCNJ2 (Kir2.1) expression [4]. All these channelopathies along with increased Na K ATPase activity have been shown to cause a positive feed-forward cycle of hypokalemia in the presence of hyperthyroid state and an additional precipitant accentuating the ion. While most cases of TPP are described in young Asian males [1,2,5,8], in this report we present a very interesting case of TPP in a young 32-year-old African American male
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