Volume 29, Issue 166, December 2025

A Case of Thyrotoxic Periodic Paralysis (TPP) with Severe Hypokalemia: Diagnostic Challenges and Management

Ghadah Sulaiman Alsaleh¹, Mamoun Bani Ali², Albaraa Mustafa Mehdar²

¹Global center for mass gathering medicine, Neom hospital emergency department, Neom, Saudi Arabia
²Neom hospital emergency department, Neom, Saudi Arabia

ABSTRACT

Background and Objectives: Thyrotoxic periodic paralysis (TPP) is a life threatening complication of hyperthyroidism, characterized by sudden onset muscle weakness and profound hypokalemia. Its dignosis is delayed, mainly in non-Asian populations or in the absence of overt thyrotoxic symptoms. This case report aims to found the diagnostic and therapeutic challenges of TPP and fortify the importance of early recognition. Case Presentation: A 37 year old Asian male presented with acute flaccid quadriparesis and severe hypokalemia (K 1.14 mEq,L). Initial ECG show sinus tachycardia and QTc prolongation. He had no known thyroid disease, but the presentation raised suspicion for TPP. Hypomagnesemia and thyrotoxicosis detected in laboratory findings. The patient was treated with IV and oral potassium, magnesium sulfate, and propranolol, which result in rapid clinical improvement. He was discharged with plans of long-term management of thyrotoxicosis. This case indicate the pathophysiology of TPP of thyroid hormone induced Na,K ATPase hyperactivity leading to intracellular potassium shifts. Conclusion: TPP should be considered in all patients presenting with acute muscle weakness and hypokalemia, regardless of ethnicity or overt thyroid symptoms. To prevent morbidity and recurrence, early diagnosis, cautious potassium repletion, betablocker therapy, and definitive treatment of thyrotoxicosis are essential.

Keywords: Thyrotoxic periodic paralysis, hypokalemia, hyperthyroidism, muscle weakness, potassium

Medical Science, 2025, 29, e224ms3767

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DOI: https://doi.org/10.54905/disssi.v29i166.e224ms3767

Published: 12 December 2025