[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-433982-105":59,"doc-detail-433982-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","thyrotoxic-hypokalemic-periodic-paralysis-pathophysiological-mechanisms","Thyrotoxic Hypokalemic Periodic Paralysis - Pathophysiological Mechanisms","","Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially fatal complication of thyrotoxicosis marked by transient muscle weakness with hypokalemia in the setting of underlying hyperthyroidism. Although thyrotoxicosis is more common in females, THPP predominantly affects males, particularly in Asian populations. Early recognition is essential to avoid cardiac arrhythmias and respiratory failure, yet misdiagnosis is frequent, especially in Western countries due to clinical overlap with familial hypokalemic periodic paralysis.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/thyrotoxic-hypokalemic-periodic-paralysis-pathophysiological-mechanisms/433982/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/thyrotoxic-hypokalemic-periodic-paralysis-pathophysiological-mechanisms/433982.png","ImageObject",300,407,{"name":92,"@type":93},"Rowan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What defines thyrotoxic hypokalemic periodic paralysis (THPP)?","Question",{"text":113,"@type":114},"THPP is characterized by transient episodes of muscle weakness together with hypokalemia and biochemical evidence of hyperthyroidism.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why is early recognition of THPP important?",{"text":118,"@type":114},"THPP can lead to serious complications including acute cardiac arrest and respiratory failure, so prompt identification helps prevent life-threatening outcomes.",{"name":120,"@type":111,"acceptedAnswer":121},"What mechanisms drive hypokalemia and paralysis in THPP?",{"text":122,"@type":114},"Thyroid hormone can upregulate Na+/K+-ATPase and increase β-adrenergic sensitivity, promoting intracellular potassium shifts; postprandial insulin surges after high carbohydrate intake and genetic susceptibility further amplify these effects.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433982,1790928302,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1099514067415,"https://ap-avatar.wpscdn.com/avatar/100002539d78ffe74a7?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779092875211072502","Review Article  \nEndocrinol Metab 2025;40:821-829 [https://doi.org/10.3803/EnM.2025.2554](https://doi.org/10.3803/EnM.2025.2554)[ ](https://doi.org/10.3803/EnM.2025.2554)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978  \nThyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms  \nGan Qing 1, Wan NurAmalina Zakaria2, Fatimah Zahra Mohamad Rom1, Wan Nor Fazila Hafizan Wan Nik3, Hani Ajrina Zulkeflee4, Siti NadirahAb Rahim5  \n1Medical Department, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur; 2Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian; 3Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu; 4Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai; 5Pathology Unit, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia  \nThyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially fatal complication of thyrotoxicosis, characterized by transient episodes of muscle weakness in the setting of hypokalemia and underlying hyperthyroidism. Although thyrotoxicosis is more common in females, THPP predominantly affects males, especially in Asian populations, in which its prevalence is notably higher. Early recognition is essential to prevent serious complications such as cardiac arrhythmias and respiratory failure; however, THPP is frequently misdiagnosed, particularly in Western countries, due to clinical overlap with familial hypokalemic periodic paralysis. The pathophysiology of THPP involves thyroid hormone–induced upregulation of Na+/K+-ATPase and heightened β-adrenergic sensitivity, which promote intracellular potassium shifts. Postprandial insulin surges following high carbohydrate intake further exacerbate this effect. Genetic susceptibility, including human leukocyte antigen haplotypes and mutations in ion channel genes (e.g., KCNE3, CACNA1S, SCN4A, and KCNJ18), plays a critical role. The resulting hypokalemia leads to hyperpolarization of muscle membranes, impairing excitability and causing paralysis. Structural muscle changes, such as sarcoplasmic reticulum proliferation and sodium channel dysfunction, may also contribute to THPP. Electrolyte abnormalities, including hypophosphatemia, hypomagnesemia, and hypocalcemia, are common due to transcellular shifts. This review underscores the importance of understanding the hormonal, genetic, and cellular mechanisms underlying THPP to enhance diagnostic accuracy and guide effective treatment strategies.  \n\n| Keywords: Thyrotoxicosis; Hypokalemia; Paralysis; Ion channels\u003Cbr>INTRODUCTION\u003Cbr>Thyrotoxic hypokalemic periodic paralysis (THPP) is a subtype of hypokalemic periodic paralysis (HPP) [1,2] characterized by the triad of transient episodic muscle weakness, hypokalemia, | and hyperthyroidism [3] . It is an uncommon presentation of thyrotoxicosis; nevertheless, several case reports have identified HPP as the first recognized manifestation of undiagnosed hyperthyroidism [4,5] .\u003Cbr>Despite its rarity, THPP is the most common form of HPP in |\n| --- | --- |\n| Received: 13 July 2025, Revised: 6 September 2025, Accepted: 13 October 2025\u003Cbr>Corresponding author: SitiNadirahAb Rahim\u003Cbr>Pathology Unit, Faculty of Medicine and Defence Health, National Defence\u003Cbr>University of Malaysia, Kem Perdana Sungai Besi, 57000 Kuala Lumpur,\u003Cbr>Malaysia\u003Cbr>Tel: +60-037622498, Fax: +60-67580404, [E-mail:](E-mail: nadirah@upnm.edu.my)[ nadirah@upnm.edu.my](E-mail: nadirah@upnm.edu.my) | Copyright © 2025 Korean Endocrine Society\u003Cbr>This is an Open Access article distributed under the terms of\u003Cbr>the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted\u003Cbr>non-commercial use, distribution, and reproduction in any medium, provided\u003Cbr>the original","cbCairCO76PlkD1S","https://ap.wps.com/l/cbCairCO76PlkD1S","pdf",837637,"English","# Introduction\n# Clinical Manifestations","[{\"question\":\"What defines thyrotoxic hypokalemic periodic paralysis (THPP)?\",\"answer\":\"THPP is characterized by transient episodes of muscle weakness together with hypokalemia and biochemical evidence of hyperthyroidism.\"},{\"question\":\"Why is early recognition of THPP important?\",\"answer\":\"THPP can lead to serious complications including acute cardiac arrest and respiratory failure, so prompt identification helps prevent life-threatening outcomes.\"},{\"question\":\"What mechanisms drive hypokalemia and paralysis in THPP?\",\"answer\":\"Thyroid hormone can upregulate Na+/K+-ATPase and increase β-adrenergic sensitivity, promoting intracellular potassium shifts; postprandial insulin surges after high carbohydrate intake and genetic susceptibility further amplify these effects.\"}]","Thyrotoxic Hypokalemic Periodic Paralysis - Pathophysiological Mechanisms | PDF",1790666463,23]