European Journal of Internal Medicine
Volume 18, Issue 5 , Pages 380-390 , September 2007

Thyrotoxic hypokalemic periodic paralysis: An overlooked pathology in western countries

  • Arsenio Pompeo

      Affiliations

    • Division of Internal Medicine, “Floraspe Renzetti” Hospital, A.S.L. 103 Lanciano-Vasto, via del Mare, 1. 66034 Lanciano (Ch), Italy
    • Corresponding Author InformationCorresponding author. Tel.: +39 0872 706394; fax: +39 0872 706461.
    • ,
  • Amleto Nepa

      Affiliations

    • Division of Internal Medicine, “Floraspe Renzetti” Hospital, A.S.L. 103 Lanciano-Vasto, via del Mare, 1. 66034 Lanciano (Ch), Italy
    • ,
  • Maurizio Maddestra

      Affiliations

    • Division of Neurology, “Floraspe Renzetti” Hospital, Lanciano (Ch), Italy
    • ,
  • Vincenzo Feliziani

      Affiliations

    • Division of Internal Medicine, “Floraspe Renzetti” Hospital, A.S.L. 103 Lanciano-Vasto, via del Mare, 1. 66034 Lanciano (Ch), Italy
    • ,
  • Nicola Genovesi

      Affiliations

    • Intensive Care Unit “Floraspe Renzetti” Hospital, Lanciano (Ch), Italy

Received 3 August 2006 ,Revised 12 March 2007 ,Accepted 16 March 2007.

References 

  1. Stedwell RE, Allen KM, Binder LS. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med. 1992;10:143–148
  2. Ko GT, Chow CC, Yeung VT, Chan HH, Li JK, Cockram CS. Thyrotoxic periodic paralysis in a Chinese population. Qjm. 1996;89:463–468
  3. Lin SH, Lin YF, Halperin ML. Hypokalaemia and paralysis. Qjm. 2001;94:133–139
  4. Kilpatrick RE, Seiler-Smith S, Levine SN. Thyrotoxic hypokalemic periodic paralysis: report of four cases in black American males. Thyroid. 1994;4:441–445
  5. Kelley DE, Gharib H, Kennedy FP, Duda RJ, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Intern Med. 1989;149:2597–2600
  6. Tassone H, Moulin A, Henderson SO. The pitfalls of potassium replacement in thyrotoxic periodic paralysis: a case report and review of the literature. J Emerg Med. 2004;26:157–161
  7. Piraino Neuenschwander P, Pumarino Carte H, Bidegain Gonzalez F, Zura Jimenez ML, Ferreiro Merino F. Thyrotoxic hypokalemic periodic paralysis: 18 cases with different forms of thyrotoxicosis. Rev Clin Esp. 1995;195:294–297
  8. Manoukian MA, Foote JA, Crapo LM. Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med. 1999;159:601–606
  9. Gaul C, Leonhardt G, Spens A, Schneyer U, Zierz S. Hypokalemic thyrotoxic periodic paralysis (HTPP). Rare differential diagnosis in case of acute tetraparesis in Europe. Med Klin (Munich). 2005;100:583–586
  10. Kodali VR, Jeffcote B, Clague RB. Thyrotoxic periodic paralysis: a case report and review of the literature. J Emerg Med. 1999;17:43–45
  11. Ober KP, Hennessy JF. Jodbasedow and thyrotoxic periodic paralysis. Arch Intern Med. 1981;141:1225–1227
  12. Ben-David D, Malnick SD, Evron E, Geltner D. Thyrotoxic hypokalaemic periodic paralysis. Lancet. 1997;349:883
  13. Wong GW, Leung TF, Lo AF, Ahuja AT, Cheng PS. Thyrotoxic periodic paralysis in a 14-year-old boy. Eur J Pediatr. 2000;159:934
  14. McFadzean AJ, Yeung R. Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J. 1967;1:451–455
  15. Bergeron L, Sternbach GL. Thyrotoxic periodic paralysis. Ann Emerg Med. 1988;17:843–845
  16. Mellgren G, Bleskestad IH, Aanderud S, Bindoff L. Thyrotoxicosis and paraparesis in a young woman: case report and review of the literature. Thyroid. 2002;12:77–80
  17. Chatot-Henry C, Smadja D, Longhi R, Brebion A, Sobesky G. Thyrotoxic periodic paralysis: two new cases in Blacks. Rev Med Interne. 2000;21:632–634
  18. Lasterra Sanchez M, Perez Perez M, Martinez Conde SC, Gavilan Villarejo I, Aguilar Diosdado M. Thyrotoxic periodic paralysis: an exceptional case report in Spanish population. An Med Interna. 1995;12:603–605
  19. Conway MJ, Seibel JA, Eaton P. Thyrotoxicosis and periodic paralysis: improvement with beta blockade. Ann Intern Med. 1974;81:332–336
  20. Nellen H, Mercado M, Mendoza V, Villanueva S, Perez M, Hernandez A, et al. Thyrotoxic periodic paralysis in Mexican mestizo patients: a clinical, biochemical and HLA-serological study. Arch Med Res. 1999;30:74–76
  21. Ghose R, Quail G, King R, Moloney P. Hypokalaemic paralysis in remote aboriginal communities. Aust Fam Physician. 1996;25:1172–1173
  22. Reisin RC, Martinez O, Moran M, Rovira M, Roccatagliata G, Pardal A, et al. Thyrotoxic periodic paralysis in Caucasians. Report of 8 cases. Neurologia. 2000;15:222–225
  23. Klouche K, Bismuth J, Lechiche C, Massanet P, Fesler P, Ribstein J, et al. Thyreotoxic periodic paralysis. A cause of pseudo-paralysing hypokalemia that should not be ignored in Caucasians. Presse Med. 2003;32:1213–1215
  24. Pandolfi C, Pellegrini L, Vitelli E, Sbalzarini G. Thyrotoxic periodic paralysis and Graves' disease. Description of an HLA-CW7-positive case. Minerva Endocrinol. 1991;16:153–155
  25. Celani MF, Bonati ME, Cavalli M. Hypokalemic thyrotoxic periodic paralysis in a Caucasian male with Graves' disease. J Endocrinol Invest. 1995;18:228–231
  26. Bazzani M, Benati L, Bosi M, Iorini M, Panizza M. Hypokalemic thyrotoxic paralysis: a rare cause of tetraparesis with acute onset in Europeans. Ital J Neurol Sci. 1998;19:307–309
  27. Messina G, Savina A. A rare case of hypokalemic thyrotoxic periodic paralysis in a Caucasian patient with Basedow's disease. Recenti Prog Med. 1999;90:392–393
  28. Didonna D, D'Alessandro G, De Michele A, Conte M, Storelli A, Totaro M, et al. Thyrotoxic periodic paralysis in a Caucasian man in treatment for Graves' disease. Panminerva Med. 2000;42:293–294
  29. Okinaka S, Shizume K, Iino S, Watanabe A, Irie M, Noguchi A, et al. The association of periodic paralysis and hyperthyroidism in Japan. J Clin Endocrinol Metab. 1957;17:1454–1459
  30. Chan A, Shinde R, Chow CC, Cockram CS, Swaminathan R. In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis. BMJ. 1991;303:1096–1099
  31. Alings AM, Fliers E, de Herder WW, Hofland LJ, Sluiter HE, Links TP, et al. A thyrotropin-secreting pituitary adenoma as a cause of thyrotoxic periodic paralysis. J Endocrinol Invest. 1998;21:703–706
  32. Laroia ST, Zaw KM, Ganti AK, Newman W, Akinwande AO. Amiodarone-induced thyrotoxicosis presenting as hypokalemic periodic paralysis. South Med J. 2002;95:1326–1328
  33. Chen YC, Fang JT, Chang CT, Chou HH. Thyrotoxic periodic paralysis in a patient abusing thyroxine for weight reduction. Ren Fail. 2001;23:139–142
  34. Sidibe EH, Diagne PM, Ly AB, Ndiaye IP, Sow AM. Thyrotoxic neuromyopathies. Rev Neurol (Paris). 1998;154:330–333
  35. Goh SH. Thyrotoxic periodic paralysis: reports of seven patients presenting with weakness in an Asian emergency department. Emerg Med J. 2002;19:78–79
  36. Sinharay R. Thyrotoxic periodic paralysis in western countries. Postgrad Med J. 2003;79:426
  37. Gonzalez-Trevino O, Rosas-Guzman J. Normokalemic thyrotoxic periodic paralysis: a new therapeutic strategy. Thyroid. 1999;9:61–63
  38. Harrison AP, Clausen T. Thyroid hormone-induced upregulation of Na+ channels and Na(+)–K+ pumps: implications for contractility. Am J Physiol. 1998;274:R864–R867
  39. Angeras U, Oldfors A, Hasselgren PO. The effect of beta-adrenergic blockade on the myopathic changes in experimental hyperthyroidism in rats. Acta Pathol Microbiol Immunol Scand [A]. 1986;94:91–99
  40. Kjeldsen K, Norgaard A, Gotzsche CO, Thomassen A, Clausen T. Effect of thyroid function on number of Na–K pumps in human skeletal muscle. Lancet. 1984;2:8–10
  41. Braden GL, von Oeyen PT, Germain MJ, Watson DJ, Haag BL. Ritodrine- and terbutaline-induced hypokalemia in preterm labor: mechanisms and consequences. Kidney Int. 1997;51:1867–1875
  42. Desai-Yajnik V, Zeng J, Omori K, Sherman J, Morimoto T. The effect of thyroid hormone treatment on the gene expression and enzyme activity of rat liver sodium–potassium dependent adenosine triphosphatase. Endocrinology. 1995;136:629–639
  43. Blanco G, Mercer RW. Isozymes of the Na–K-ATPase: heterogeneity in structure, diversity in function. Am J Physiol. 1998;275:F633–F650
  44. Lam KS, Yeung RT, Benson EA, Wang C. Erythrocyte sodium–potassium pump in thyrotoxic periodic paralysis. Aust N Z J Med. 1989;19:6–10
  45. Chronos N, Mendel P, Ozin RL. Thyrotoxicosis presenting as a life threatening hypokalaemic paralysis: investigation of the Na/K pump in isolated leucocytes. Br J Clin Pract. 1993;47:106–108
  46. MacDermott M. The effect of tri-iodothyronine on the membrane potential and intracellular sodium and potassium activities of rat soleus and extensor digitorum longus muscles. J Endocrinol. 1993;138:503–507
  47. De Riva C, Vircici F. Impaired Na+,K+ATPase activity in red blood cells in euthyroid women treated with levothyroxine after total thyroidectomy for Graves' disease. Metabolism. 1998;47:1194–1198
  48. Marx A, Ruppersberg JP, Pietrzyk C, Rudel R. Thyrotoxic periodic paralysis and the sodium/potassium pump. Muscle Nerve. 1989;12:810–815
  49. Tang NL, Chow CC, Ko GT, Tai MH, Kwok R, Yao XQ, et al. No mutation in the KCNE3 potassium channel gene in Chinese thyrotoxic hypokalaemic periodic paralysis patients. Clin Endocrinol (Oxf). 2004;61:109–112
  50. Sternberg D, Tabti N, Fournier E, Hainque B, Fontaine B. Lack of association of the potassium channel-associated peptide MiRP2-R83H variant with periodic paralysis. Neurology. 2003;61:857–859
  51. Seppet EK, Kolar F, Dixon IM, Hata T, Dhalla NS. Regulation of cardiac sarcolemmal Ca2+ channels and Ca2+ transporters by thyroid hormone. Mol Cell Biochem. 1993;129:145–159
  52. Riis AL, Jorgensen JO, Moller N, Weeke J, Clausen T. Hyperthyroidism and cation pumps in human skeletal muscle. Am J Physiol Endocrinol Metab. 2005;288:E1265–E1269
  53. Hu R, Beck C, Chang YB, DeGroot LJ. HLA class II genes in Graves' disease. Autoimmunity. 1992;12:103–106
  54. Tamai H, Tanaka K, Komaki G, Matsubayashi S, Hirota Y, Mori K, et al. HLA and thyrotoxic periodic paralysis in Japanese patients. J Clin Endocrinol Metab. 1987;64:1075–1078
  55. Lazarus JH. Hyperthyroidism. Lancet. 1997;349:339–343
  56. Gallagher EJ. Is thyrotoxic periodic paralysis a “channelopathy”?. J Emerg Med. 1999;17:123–127
  57. Dias Da Silva MR, Cerutti JM, Arnaldi LA, Maciel RM. A mutation in the KCNE3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis. J Clin Endocrinol Metab. 2002;87:4881–4884
  58. Lane AH, Markarian K, Braziunene I. Thyrotoxic periodic paralysis associated with a mutation in the sodium channel gene SCN4A. J Pediatr Endocrinol Metab. 2004;17:1679–1682
  59. Ng WY, Lui KF, Thai AC, Cheah JS. Absence of ion channels CACN1AS and SCN4A mutations in thyrotoxic hypokalemic periodic paralysis. Thyroid. 2004;14:187–190
  60. Kung AW, Lau KS, Fong GC, Chan V. Association of novel single nucleotide polymorphisms in the calcium channel alpha 1 subunit gene (Ca(v)1.1) and thyrotoxic periodic paralysis. J Clin Endocrinol Metab. 2004;89:1340–1345
  61. Wang W, Jiang L, Ye L, Zhu N, Su T, Guan L, et al. Mutation screening in Chinese hypokalemic periodic paralysis patients. Mol Genet Metab. 2006;87:359–363
  62. Kung AW, Lau KS, Cheung WM, Chan V. Thyrotoxic periodic paralysis and polymorphisms of sodium–potassium ATPase genes. Clin Endocrinol (Oxf). 2006;64:158–161
  63. Kim TY, Song JY, Kim WB, Shong YK. Arg16Gly polymorphism in beta2-adrenergic receptor gene is not associated with thyrotoxic periodic paralysis in Korean male patients with Graves' disease. Clin Endocrinol (Oxf). 2005;62:585–589
  64. Hundal HS, Marette A, Mitsumoto Y, Ramlal T, Blostein R, Klip A. Insulin induces translocation of the alpha 2 and beta 1 subunits of the Na+/K(+)-ATPase from intracellular compartments to the plasma membrane in mammalian skeletal muscle. J Biol Chem. 1992;267:5040–5043
  65. Ewart HS, Klip A. Hormonal regulation of the Na(+)–K(+)-ATPase: mechanisms underlying rapid and sustained changes in pump activity. Am J Physiol. 1995;269:C295–C311
  66. Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore). 1992;71:109–120
  67. Kurihara K, Maruyama S, Hosoi K, Sato S, Ueha T, Gresik EW. Regulation of Na+,K+-ATPase in submandibular glands of hypophysectomized male mice by steroid and thyroid hormones. J Histochem Cytochem. 1996;44:703–711
  68. Lajara-Nanson WA. Cocaine induced hypokalaemic periodic paralysis. J Neurol Neurosurg Psychiatry. 2002;73:92
  69. Hoffman RJ, Hoffman RS, Freyberg CL, Poppenga RH, Nelson LS. Clenbuterol ingestion causing prolonged tachycardia, hypokalemia, and hypophosphatemia with confirmation by quantitative levels. J Toxicol Clin Toxicol. 2001;39:339–344
  70. Appel CC, Myles TD. Caffeine-induced hypokalemic paralysis in pregnancy. Obstet Gynecol. 2001;97:805–807
  71. Talbott JH. Periodic paralysis. Medicine. 1941;20:82–142
  72. Liu YC, Tsai WS, Chau T, Lin SH. Acute hypercapnic respiratory failure due to thyrotoxic periodic paralysis. Am J Med Sci. 2004;327:264–267
  73. Chia BL, Lee KH, Cheah JS. Sino-atrial Wenckebach conduction in thyrotoxic periodic paralysis: a case report. Int J Cardiol. 1995;47:285–289
  74. Gennari FJ. Hypokalemia. N Engl J Med. 1998;339:451–458
  75. Noto H, Mitsuhashi T, Ishibashi S, Kimura S. Hyperthyroidism presenting as dysphagia. Intern Med. 2000;39:472–473
  76. Schutta HS, Armitage JL. Thyrotoxic hypokalemic periodic paralysis. J Neuropathol Exp Neurol. 1969;28:321–336
  77. Kumazawa K, Sobue G, Okamoto H, Yuasa K, Mitsuma T. Two cases of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with Graves' disease. Rinsho Shinkeigaku. 1991;31:768–771
  78. Mattos VM, de Mattos JP, Lucca I, Giorelli PC. Polyneuropathy in the course of hyperthyroidism: report of a case. Arq Neuropsiquiatr. 1984;42:282–288
  79. Guzowski K, Gulewicz E. Case of acute thyreotoxic Waldenstrom's encephalopathy. Neurol Neurochir Pol. 1977;11:371–373
  80. Jabbari B, Huott AD. Seizures in thyrotoxicosis. Epilepsia. 1980;21:91–96
  81. Rocha MS, Brucki SM, Ferraz AC. Cerebral vasculitis and Basedow–Graves disease: report of two cases. Arq Neuropsiquiatr. 2001;59:948–953
  82. Pou Serradell A, Roquer Gonzalez J, Corominas Torres JM, Lloreta Trull J, Oliva Bielsa J, Ugarte Elola A. Amyotrophic lateral sclerosis syndrome and hyperthyroidism. Cure with antithyroid drugs. Rev Neurol (Paris). 1990;146:219–220
  83. Bertola G, Ausenda C, Bocchia M, Grassi F, Ciani M, Sassi L. Bulbar paralysis and flaccid tetraparesis in thyrotoxicosis. Recenti Prog Med. 2002;93:169–171
  84. Nagaoka T, Matsushita S, Nagai Y, Kobayashi K. A woman who trembled, then had chorea. Lancet. 1998;351:1326
  85. Fridberg DI, Kalinin AP. On the combination of thyrotoxicosis and parkinsonism. Zh Nevropatol Psikhiatr Im S S Korsakova. 1968;67:1160–1162
  86. Melamed E, Berman M, Lavy S. Letter: Posterolateral myelopathy associated with thyrotoxicosis. N Engl J Med. 1975;293:778–779
  87. Widjaja A, Rademaker J, Golkel C, Holstein A, Leifke E, Wat N. Graves ophthalmopathy and ocular myasthenia. Ophthalmologe. 2000;97:38–40
  88. Ghobrial MW, Ruby EB. Coma and thyroid storm in apathetic thyrotoxicosis. South Med J. 2002;95:552–554
  89. Navarro V, Fournier E, Girard S, Delattre JY, Eymard B. Periodic hypokalemic paralysis as the manifestation of Graves' disease: clinical and electrophysiological study. Rev Neurol (Paris). 2000;156:59–61
  90. Schulman M, Narins RG. Hypokalemia and cardiovascular disease. Am J Cardiol. 1990;65:4E–9E[discussion 22E–23E]
  91. Lichtstein DM, Arteaga RB. Rhabdomyolysis associated with hyperthyroidism. Am J Med Sci. 2006;332:103–105
  92. Hardiman O, Molloy F, Brett F, Farrell M. Inflammatory myopathy in thyrotoxicosis. Neurology. 1997;48:339–341
  93. Korenyi-Both A, Korenyi-Both I, Kayes BC. Thyrotoxic myopathy. Pathomorphological observations of human material and experimentally induced thyrotoxicosis in rats. Acta Neuropathol (Berl). 1981;53:237–248
  94. Puvanendran K, Cheah JS, Naganathan N, Yeo PP, Wong PK. Neuromuscular transmission in thyrotoxicosis. J Neurol Sci. 1979;43:47–57
  95. Goswami R, Guleria R, Gupta AK, Gupta N, Marwaha RK, Pande JN, et al. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy. Eur J Endocrinol. 2002;147:299–303
  96. Ahlawat SK, Sachdev A. Hypokalaemic paralysis. Postgrad Med J. 1999;75:193–197
  97. Birkhahn RH, Gaeta TJ, Melniker L. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med. 2000;18:199–202
  98. Levey GS, Klein I. Catecholamine–thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism. Am J Med. 1990;88:642–646
  99. Kramer MR, Shilo S, Hershko C. Atrioventricular and sinoatrial block in thyrotoxic crisis. Br Heart J. 1985;54:600–602
  100. Toft P, Botker HE. Hyperthyroidism and heart disease. Is thyrotoxic cardiomyopathy a disease entity?. Ugeskr Laeger. 1993;155:1354–1357
  101. Yu YH, Bilezikian JP. Tachycardia-induced cardiomyopathy secondary to thyrotoxicosis: a young man with previously unrecognized Graves' disease. Thyroid. 2000;10:923–927
  102. Choudhury RP, MacDermot J. Heart failure in thyrotoxicosis, an approach to management. Br J Clin Pharmacol. 1998;46:421–424
  103. Fisher J. Thyrotoxic periodic paralysis with ventricular fibrillation. Arch Intern Med. 1982;142:1362–1364
  104. Loh KC, Pinheiro L, Ng KS. Thyrotoxic periodic paralysis complicated by near-fatal ventricular arrhythmias. Singapore Med J. 2005;46:88–89
  105. Helfant RH. Hypokalemia and arrhythmias. Am J Med. 1986;80:13–22
  106. Hsu YJ, Lin YF, Chau T, Liou JT, Kuo SW, Lin SH. Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis. Am J Med Sci. 2003;326:128–132
  107. Webb Youdale S, Gatell Artigas JM, Soriano Marin E, Garcica San Miquel J. Hypercalcemia as first manifestation of thyrotoxicosis (author's transl). Med Clin (Barc). 1980;74:107–108
  108. Szeto CC, Chow CC, Li KY, Ko TC, Yeung VT, Cockram CS. Thyrotoxicosis and renal tubular acidosis presenting as hypokalaemic paralysis. Br J Rheumatol. 1996;35:289–291
  109. Nora NA, Berns AS. Hypokalaemic, hypophosphatemic thyrotoxic periodic paralysis. Am J Kidney Dis. 1989;13:247–249
  110. Lin SH. Thyrotoxic periodic paralysis. Mayo Clin Proc. 2005;80:99–105
  111. Goswami R, Shah P, Ammini AC. Thyrotoxicosis with osteomalacia and proximal myopathy. J Postgrad Med. 1993;39:89–90
  112. Norris KC, Levine B, Ganesan K. Thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia. Am J Kidney Dis. 1996;28:270–273
  113. Ryzen E, Servis KL, Rude RK. Effect of intravenous epinephrine on serum magnesium and free intracellular red blood cell magnesium concentrations measured by nuclear magnetic resonance. J Am Coll Nutr. 1990;9:114–119
  114. Lee KO, Taylor EA, Oh VM, Cheah JS, Aw SE. Hyperinsulinaemia in thyrotoxic hypokalaemic periodic paralysis. Lancet. 1991;337:1063–1064
  115. Zura ML, Contreras P, Aguirre C, Piraino P, Andrade A. Hyperinsulinemia in thyrotoxic hypokalemic periodic paralysis: 2 clinical cases. Rev Med Chil. 1994;122:309–312
  116. Fong TL, McHutchison JG, Reynolds TB. Hyperthyroidism and hepatic dysfunction. A case series analysis. J Clin Gastroenterol. 1992;14:240–244
  117. Lu KC, Hsu YJ, Chiu JS, Hsu YD, Lin SH. Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis. Am J Emerg Med. 2004;22:544–547
  118. Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab. 2006;91:2490–2495
  119. al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiologic and clinical overview. Am J Kidney Dis. 1994;24:737–752
  120. Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988;77:392–397
  121. Seller RH. The role of magnesium in digitalis toxicity. Am Heart J. 1971;82:551–556
  122. Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis. 2001;37:620–623
  123. Shayne P, Hart A. Thyrotoxic periodic paralysis terminated with intravenous propranolol. Ann Emerg Med. 1994;24:736–740
  124. Yeung RT, Tse TF. Thyrotoxic periodic paralysis. Effect of propranolol. Am J Med. 1974;57:584–590
  125. Hsieh CH, Kuo SW, Pei D, Hung YJ, Chyi-Fan S, Wu LI, et al. Thyrotoxic periodic paralysis: an overview. Ann Saudi Med. 2004;24:418–422
  126. Shulkin D, Olson BR, Levey GS. Thyrotoxic periodic paralysis in a Latin-American taking acetazolamide. Am J Med Sci. 1989;297:337–338
  127. McHutchison JG, Melick RA, Wark JD. Hypokalemic periodic paralysis of thyrotoxic origin. Aust N Z J Med. 1987;17:455–456
  128. Liu Z, Braverman LE, Malabanan A. Thyrotoxic periodic paralysis in a Hispanic man after the administration of prednisone. Endocr Pract. 2006;12:427–431

PII: S0953-6205(07)00102-1

doi: 10.1016/j.ejim.2007.03.003

European Journal of Internal Medicine
Volume 18, Issue 5 , Pages 380-390 , September 2007

Article Tools

* Image Usage & Resolution