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Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years
Journal article   Open access   Peer reviewed

Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years

Jeng-Chuan Shiang, Chih-Jen Cheng, Ming-Kai Tsai, Yi-Jen Hung, Yu-Juei Hsu, Sung-Sen Yang, Shi-Jye Chu and Shih-Hua Lin
European journal of endocrinology, Vol.161(6), pp.911-916
12/01/2009
DOI: 10.1530/EJE-09-0553
PMID: 19755408
url
https://doi.org/10.1530/EJE-09-0553View
Published (Version of record) Open Access

Abstract

Objective: To characterize the course of therapy in a large cohort of Chinese patients with thyrotoxic periodic paralysis (TPP), a reversible electrolyte emergency fraught with therapeutic challenges. Design and methods In this prospective interventional study, 78 patients with TPP (75 males and three females with an age range of 16-48 years) were consecutively enrolled over a 6-year period. Intravenous KCl at a rate of 10 mmol/h was administered until muscle strength recovered Serum potassium (K+) and phosphorus concentrations were measured hourly during the paralytic attack and for 6 h after recovery. Results. The serum potassium (K+) on attack was 2.1 +/- 0.2 mmol/l. The dose of KCl administered to restore muscle strength was 63 +/- 32 mmol, and peak serum K+ concentration after recovery was 5.3 +/- 0.5 mmol/l A paradoxical fall in serum K+ concentration > 0.1 mmol/l difference between presentation and treatment nadir was observed in approximately one-fourth of TPP patients (n = 20) These patients had significantly higher serum-free thyroxine concentration, systolic blood pressure. and heart rate on presentation, as well as serum phosphate concentration on recovery. They not only needed much more KCl supplementation (104 +/- 34 vs 48 +/- 19 mmol. P < 0.001). but also had significantly more severe rebound hyperkalemia (5.8 +/- 0.5 vs 5.1 +/- 0.4 mmol/l. P < 0.001) on recovery than those who did not have paradoxical hypokalemia. There was a positive correlation between the dose of KCl administered and the difference between peak and nadir serum K+ (Delta K+) (r=0.68, P < 0.001) Conclusions TPP patients who do not develop paradoxical hypokalema need a smaller KCl dose to achieve recovery, whereas those who develop paradoxical hypokalemia have more severe hyperthyroidism and hyperadrenergic activity and may require blockage of intracellular K+ shift to prevent rebound hyperkalemia.
 Endocrinology & Metabolism Life Sciences & Biomedicine Science & Technology

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