Thyrotoxic periodic paralysis due to excessive L-thyroxine replacement in a Caucasian man

This version was published on 1 September 2009

Ann Clin Biochem 2009;46:423-425
© 2009 Association for Clinical Biochemistry


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Case Reports

M J Hannon,
L A Behan and
A Agha

Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland

Corresponding author: Dr Amar Agha, Academic Department of Endocrinology, Beaumont Hospital, Dublin 9, Ireland. Email: amaragha{at}

Thyrotoxic periodic paralysis is a potentially fatal complicationof hyperthyroidism, more common in Asian races, which is definedby a massive intracellular flux of potassium. This leads toprofound hypokalaemia and muscle paralysis. Although the paralysisis temporary, it may be lethal if not diagnosed and treatedrapidly, as profound hypokalaemia may induce respiratory muscleparalysis or cardiac arrest. The condition is often misdiagnosedin the west due to its comparative rarity in Caucasians; howeverit is now increasingly described in Caucasians and is also beingseen with increasing frequency in western hospitals due to increasingimmigration and population mobility. Here we describe the caseof a patient with panhypopituitarism due to a craniopharyngioma,who developed thyrotoxic periodic paralysis due to excessiveL-thyroxine replacement. This disorder has been described inAsian subjects but, to our knowledge, thyrotoxic periodic paralysissecondary to excessive L-thyroxine replacement has never beendescribed in Caucasians.

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