Diagnosing thyrotoxic periodic paralysis in the ED

Yuh Feng Lin, Chia Chao Wu, Dee Pei, Shi Jye Chu, Shih Hua Lin

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (SPP) are the most common causes of hypokalemic periodic paralysis (HPP) in EDs in Asia. Their neuromuscular presentations are almost indistinguishable. We conducted this study to identify clinical clues that can help EPs distinguish between TPP and SPP. Thirty-four patients presenting to the ED with HPP were enrolled during a 3-year period. They did not have known hyperthyroidism before the attack and no family history of paralysis. They all had low K+ excretion rates. Vital signs and blood biochemistry, including acid-base and electrolytes, were measured. TPP was subsequently established by thyroid function tests. Twenty patients had TPP and 14 patients had SPP. There was no significant difference in age and sex distribution between them. Systolic (SBP) but not diastolic blood pressure (SBP 146 ± 4 vs 128 ± 4 mm Hg, P < 0.001) and heart rate (106 ± 3 vs 73 ± 3 beats/min, P < 0.001) were significantly higher in those experiencing TPP than SPP. Among the biochemical factors, only plasma phosphate concentration (2.2 ± 0.2 vs 3.2 ± 0.2 mg/dL, P < 0.001) was significantly lower in those experiencing TPP than SPP. Systolic hypertension, tachycardia, and hypophosphatemia are clinical clues favoring the diagnosis of TPP.

Original languageEnglish
Pages (from-to)339-342
Number of pages4
JournalAmerican Journal of Emergency Medicine
Issue number4
Publication statusPublished - Jul 2003
Externally publishedYes


  • Beta-blockers
  • Blood pressure
  • Heart rate
  • Hyperthyroidism
  • Hypokalemia
  • Hypophosphatemia
  • Paralysis

ASJC Scopus subject areas

  • Emergency Medicine


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