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Thyrotoxic periodic paralysis
From WikEM
Contents
Background
- Periodic paralysis occurs from hypokalemia, hyperkalemia, and hyperthyroidism
- More common in males
- More common in Asians
- A variant of hypokalemic periodic paralysis
Clinical Features
- Painless weakness especially after exercise or diet changes
- Lasting hours to days
- Most common from 20-40 years old
- Physical Exam
- Proximal>Distal muscle weakness
- Hyporeflexia or areflexia
Differential Diagnosis
Weakness
- Neuromuscular weakness
- UMN:
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Guillain-Barre syndrome
- Toxins (Ciguatera)
- Tick paralysis
- DM neuropathy (non-emergent)
- NMJ disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Hypokalemic periodic paralysis
- Thyrotoxic periodic paralysis
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Evaluation
- Hypokalemia
- Thyrotoxicosis
- EMG
Management
Disposition
- Telemetry admission
- Endocrine consult
