EP1488 - ECE_2677 - Association of thyrotoxic periodic paralysis with long-term risk of incident diabetes: a population-based cohort study

Abstract Introduction Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis, characterized by episodes of muscle paralysis and hypokalemia. During acute attacks, patients with TPP were observed to develop hyperinsulinemia triggered by precipitating factors such as carbohydrate load. Compared to patients with thyrotoxicosis but not TPP (simple thyrotoxicosis), those with TPP exhibited higher insulin levels even after the resolution of paralytic episodes. In this study, we aimed to evaluate the association of TPP with the long-term risk of developing diabetes. Methods We conducted a retrospective cohort study using a representative electronic health record database in Hong Kong. Individuals with first TPP and simple thyrotoxicosis between 2002 and 2016 were identified, and followed until the development of incident diabetes, death, or end of study on 31 December 2021. Propensity score (PS) matching was used to balance the baseline characteristics, matching each individual with TPP history with up to four individuals with simple thyrotoxicosis. Cox proportional hazards model was applied to estimate the hazard ratio (HR) for incident diabetes among individuals with TPP history compared to those with simple thyrotoxicosis. Results Between 2002 and 2016, a total of 631 individuals developed incident TPP, while 16 240 developed simple thyrotoxicosis. Using the PS approach, 630 individuals with TPP were matched to 1654 individuals with simple thyrotoxicosis. Over a median follow-up of more than 11 years, the incidence rate of diabetes was 11.03 per 1000 person-years (95% confidence interval [CI]: 8.72-13.77) in the TPP group and 6.6 per 1000 person-years (95% CI: 5.51-7.85) in the simple thyrotoxicosis group. In time-to-event analysis, individuals with TPP history had significantly higher risk of incident diabetes compared to those with simple thyrotoxicosis (HR = 2.25; 95% CI: 1.61-3.14; P < .001). Sensitivity analyses restricted to individuals with at least 10 and 15 years of follow-up time yielded similar results (10-year follow-up: HR = 2.33; 95% CI: 1.55-3.51; P < .001; 15-year follow-up: HR = 2.18; 95% CI: 1.54-3.09; P < .001). Conclusions Individuals with TPP history exhibited a significantly higher long-term risk of developing diabetes compared to those with simple thyrotoxicosis. Regular monitoring for diabetes may be warranted in individuals with TPP history to facilitate early detection and timely intervention.