Periodic Paralysis and the Emergency Department: A Case Series of Thyrotoxicosis Periodic Paralysis with Literature Review

Thyrotoxic periodic paralysis is a rare but serious complication of thyrotoxic. It is an uncommon form of hypokalemic periodic paralysis characterized by proximal muscle weakness that may progress to involve distal muscle and respiratory muscle. Thyrotoxic periodic paralysis is commonly reported among Asian descent; especially the male population, between the ages of 20 and 40 years. The actual pathophysiology of Thyrotoxic periodic paralysis is unclear. However, hyperthyroidism, channelopathies, high-carbohydrate food, and hyperandrogenism are the most common predisposing factors associated with this condition. Hypokalemia and muscle weakness in Thyrotoxicosis patients result from increased shifting of K+ intracellularly. This is known to be related to increased sodium-potassium-a adenosine triphosphatase (Na/K-ATPase) pump number and activity. The proper aim of treatment in Thyrotoxicosis patients is to reach the euthyroid state.  Management of Thyrotoxic periodic paralysis at the Emergency department includes establishing Intravenous potassium replacement, starting non-selective beta-blockers to reduce the phosphate and potassium intracellular shifting, and normalizing the underlying hyperthyroid state.  Here, we present two cases of Thyrotoxic Periodic Paralysis. These cases reiterate the need to consider all the complications of Thyrotoxicosis, even rare ones, to treat the condition and reverse the effect of periodic hypokalemia within the Emergency Department, to prevent any inevitable complication.