Sudden weakness due to thyrotoxic periodic paralysis: a case report

Rizaldy Taslim Pinzon(1), Bulan Marchellia Wijaya(2), Edwin Timoti Japanto(3*)

(1) Departement of Neurology, Bethesda Hospital, Faculty of Medicine Duta Wacana Christian University, Yogyakarta, Indonesia
(2) Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
(3) Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
(*) Corresponding Author


Thyrotoxic periodic paralysis (TPP) is a complication of hyperthyroidism. Lead to sudden hypokalemia and muscle weakness. In most cases, it is found mainly in young adult males of the Asian race. The paralysis is temporary and will return with potassium correction. There are very few cases reported in Indonesia regarding these cases of TPP. In our case, a 44-year old man complained of weakness that started later in the limbs but quickly improved. This case was diagnosed late at first, and uncorrected potassium levels led to recurrent paralysis. Laboratory test results showed severe hypokalemia (potassium level 1.81 mmol/L). The thyroxine level (T4) was 44.12 pmol/L and low serum thyroid-stimulating hormone (TSH) <0.0025 IU/mL.


hyperthyroidism; paralysis; hypokalemia; thyrotoxicosis; T4

Full Text:



Vijayakumar A, Ashwath G, Thimmappa D. Thyrotoxic periodic paralysis: Clinical challenges. J Thyroid Res 2014; 2014:649502.
2.Salih M, Van Kinschot CMJ, Peeters RP, De Herder WW, Duschek EJJ, Van Der Linden J, et al. Thyrotoxic periodic paralysis: An unusual presentation of hyperthyroidism. Neth J Med 2017; 75(8):315-20.
3.Garla VV, Gunturu M, Kovvuru KR, Salim SA. Thyrotoxic periodic paralysis: case report and review of the literature. Electronic Physician 2018; 10(8):7174-9.
4.Lafi BG, Moteri Al, Aslam M. Case report thyrotoxic periodic paralysis: a case report. Int J Healt Sci 2017; 11(1):1-2.
5.Lin SH, Huang CL. Mechanism of thyrotoxic periodic paralysis. J Am Soc Nephrol 2012; 23(6):985-8.
6.Pardede SO, Fahriani R. Paralisis periodik hipokalemik familial. Cermin Dunia Kedokt. 2012; 39(10):727-30.
7.Siddamreddy S, Dandu VH. Thyrotoxic periodic paralysis. In Treasure Island (FL); 2020.
8.Karndumri K, Thewjitcharoen Y, Chatchomchuan W, Porramatikul S, Krittiyawong S, Wanothayaroj E, et al. Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis. J Clin Transl Endocrinol 2021; 21:100235.
9.Naji W. Acute respiratory failure and ventricular arrhythmia secondary to thyrotoxic periodic paralysis : when k is the key. Chest 2021; 154(4):246A.
10.Haider M, Khan Chachar AZ, Munir A. Thyrotoxic periodic paralysis. J Ayub Med Coll Abbottabad 2019; 31(4):619-21.
11.Iqbal QZ, Niazi M, Zia Z, Sattar SBA. A literature review on thyrotoxic periodic paralysis. Cureus 2020; 12(8):e10108. 10.7759/cureus.10108
12.Silverman E, Haber LA, Geha RM. Lift then shift: thyrotoxic periodic paralysis. Am J Med 2021; 132(1):e3-6.
13.Penev D, Rotering C, Pusl T. Sudden night palsy in a young man : thyrotoxic periodic paralysis as a first manifestation of hyperthyroidism. Am J Med 2021; 133(6):e300-1.
14.Al-Rafaie N, Appiah S, Mandal AKJ, Missouris CG. Don’t trip over the trop: an unusual presentation of thyrotoxic periodic paralysis. Am J Med 2021; 132(10):1166-9.
15.Ghalyoun BA, Khaddash I, Mourad I, Shamoon D, Linaac A, Tiyyagura S. Thyrotoxic periodic paralysis crosses boarders from muscles to the heart: a case of hypokalemic ventricular tachycardia. J Am Coll Cardiol 2019; 73(9):2323.
16.Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: New insights and implications for therapy. Front Physiol 2018; 9:1500.
17.Phuyal P, Nagali S. Hypokalemic periodic paralysis. Treasure Island (FL): StatPearls Publishing; 2021.


Article Metrics

Abstract views : 1016 | views : 1173

Copyright (c) 2022 Rizaldy Taslim Pinzon, Bulan Marchellia Wijaya, Edwin Timoti Japanto

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats


Creative Commons License
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.