Title: Thyrotoxic Periodic Paralysis - Are We Underestimating the Incidence
Authors: Ranadheer Gupta Manthri, Tejonath Gadepalli, Santi Bushan Murari, Pushpalatha S, Prabhaker Rao VVS
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.49
1. Thyrotoxic periodic paralysis (TPP) is a condition featuring attacks of muscle weakness in the presence of hyperthyroidism. This study was conducted to know the incidence and method of prevention of thyrotoxic periodic paralysis in patients with thyrotoxicosis treated with radioactive iodine.200 Patients with thyrotoxicosis after withholding anti thyroid drugs were treated with radioactive iodine from 2006 September to 2008 March were analysed for symptoms of periodic paralysis post radio iodine treatment setting. Out of 200 patients 100 patients included in control group were educated about thyrotoxic periodic paralysis and were asked to take natural potassium supplements like coconut water among which 83 patients were given natural supplementation with high potassium diet and the remaining 17 patients received syrup potchlor 2 mL twice daily based on the severity of the thyrotoxicosis. Other 100 patients who were in the test group were not supplemented with potassium and not educated about thyrotoxic periodic paralysis. Out of the 100 patients who did not receive any potassium supplementation 44 patients presented with generalised muscle weakness in the first 4 weeks post radio iodine therapy, 5 patients presented with periodic paralysis and 1 patient expired due to arrhythmia with ECG evidence of hypokalemic changes, Serum potassium levels less than 3 mEqv/L. Among the rest of the 100 patients who received oral supplementation only 1 presented with symptoms suggestive of thyrotoxic periodic paralysis. The incidence of thyrotoxic periodic paralysis is high in the first four to six weeks post radio iodine therapy because of withholding antithyroid drugs as well as initial radio iodine induced thyroiditis. Oral natural potassium supplementation post radio iodine therapy for initial 6 weeks is an adequate prophylactic measure to prevent the morbidity and remote mortality from thyrotoxic hypokalemic periodic paralysis in patients being treated with radioactive iodine. Key Words: Thyrotoxic Periodic Paralysis, Hypokalemia, Thyrotoxicosis. 1. Gennari FJ, Hypokalemia, N Engl J Med, Vol.339(7), pp.451-458,1998. 2. 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, vol. 303(6810), pp.1096–1099,1991. 3. Lin SH, Thyrotoxic periodic paralysis, Mayo Clin Proc, vol.80(1), pp.99–105,2005. 4. GS, Klein I, Catecholamine-thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism, Am J Med, vol.88(6), pp.642–646,1990. 5. Ginsberg AM, Clutter WE, Shah SD, Cryer PE, Triiodothyronine-induced thyrotoxicosis increases mononuclear leukocyte beta-adrenergic receptor density in man, J Clin Invest, vol.67(6), pp.1785–1791,1981. 6. Lee KO, Taylor EA, et al, Hyperinsulinemia in thyrotoxic hypokalemic periodic paralysis, Lancet, vol.337(8749), pp.1063–1064, 1991. 7. Lien Lam, Rajasree J. Nair et al, proc(bayl univ med cent), vol.19(2), pp.126–129,2006. 8. Kemperman FA, Hoff HC, de Klerk G, Hypokalemic periodic paralysis as the sole manifestation of hyperthyroidism, Ned Tijdschr Geneeskd, vol. 139, pp. 938-941,1995. 9. Manoukian MA, Foote JA, Crapo LM, Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes, Arch Intern Med, vol.159(6),pp.601–606,1999. 10. 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, vol.26(2), pp.157–161,2004. 11. 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, vol.22(7), pp.544–547,2004.Abstract
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