[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-458911-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-458911-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","thyrotoxic-periodic-paralysis-tpp-a-comprehensive-review-regional-insights-from-the-middle-east","Thyrotoxic Periodic Paralysis (TPP) : A Comprehensive Review - Regional Insights from the Middle East","","Thyrotoxic periodic paralysis (TPP) is a rare, potentially life-threatening cause of acute flaccid paralysis, driven by hypokalemia in the setting of thyrotoxicosis and often missed in emergency care. A narrative literature review summarizes adult TPP evidence up to 31 October 2025, integrating clinical presentation, triggers, diagnostic errors, and treatment. Findings emphasize young male predominance, carbohydrate- and exercise-related precipitants, β-agonist triggers, frequent misdiagnosis, and the need for early hypokalemia correction, non-selective β-blockade, and definitive control of thyrotoxicosis to prevent recurrence.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/thyrotoxic-periodic-paralysis-tpp-a-comprehensive-review-regional-insights-from-the-middle-east/458911/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/thyrotoxic-periodic-paralysis-tpp-a-comprehensive-review-regional-insights-from-the-middle-east/458911.png","ImageObject",300,407,{"name":42,"@type":43},"Mafia Boss","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is thyrotoxic periodic paralysis (TPP) dangerous and easy to miss in emergency settings?","Question",{"text":63,"@type":64},"TPP can cause acute flaccid paralysis and is associated with marked hypokalemia during thyrotoxicosis. The article notes it is often misdiagnosed in emergency departments, including when thyrotoxicosis is subtle.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What triggers are commonly associated with TPP episodes?",{"text":68,"@type":64},"High-carbohydrate meals, strenuous exercise, and β-agonists are described as common triggers. Middle Eastern reports are discussed as showing broadly similar clinical patterns.",{"name":70,"@type":61,"acceptedAnswer":71},"What management steps does the review highlight to prevent recurrence?",{"text":72,"@type":64},"The review emphasizes early correction of hypokalemia, non-selective β-blockade, and definitive control of thyrotoxicosis. It also proposes an ED-focused approach that includes rapid thyroid function testing and structured potassium replacement and β-blocker protocols.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},458911,1790928371,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146,"preview_page_count":4},962090760730,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 11/24/2025  \nReview ended 12/03/2025  \nPublished 12/09/2025  \n© Copyright 2025  \nAlrashidi. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98814  \nOpen Access Review Article  \nThyrotoxic Periodic Paralysis (TPP) : A Comprehensive Review with Regional Insights from the Middle East  \nFahad S. Alrashidi 1  \n1. Internal Medicine/Nephrology, Ad Diriyah Hospital, Riyadh Third Health Cluster, Riyadh, SAU Corresponding author: Fahad S. Alrashidi, [falrashedi@icloud.com](falrashedi@icloud.com)  \nAbstract  \nBackground: Thyrotoxic periodic paralysis (TPP) is a rare but potentially life-threatening cause of acute flaccid paralysis, characterized by hypokalemia in the setting of thyrotoxicosis and often misdiagnosed in emergency departments.  \nMethods: We conducted a narrative literature review ofTPP in adults using major databases up to 31 October 2025, with a focus on clinical presentation, precipitants, diagnostic pitfalls, and management, and we synthesized Middle Eastern case data alongside global experience.  \nResults: TPP typically affects younger males and may be the first manifestation of hyperthyroidism. Highcarbohydrate meals, strenuous exercise, and β-agonists are common triggers. Misdiagnosis as Guillain-Barré syndrome or other neuromuscular conditions is frequent, particularly when thyrotoxicosis is subtle. Middle Eastern reports suggest similar clinical patterns but highlight delayed recognition and variable access to thyroid testing. Early correction of hypokalemia, non-selective beta (β)-blockade, and definitive control of thyrotoxicosis are essential to prevent recurrences.  \nConclusions: An emergency department (ED)-focused approach that routinely considers TPP in acute flaccid paralysis, integrates rapid thyroid function testing, and follows structured potassium replacement and β -blocker protocols can reduce diagnostic delay and improve outcomes. Incorporating regional data may help tailor awareness campaigns and management pathways in Middle Eastern and other underrepresented settings.  \nCategories: Internal Medicine, Nephrology, Endocrinology/Diabetes/Metabolism  \nKeywords: arrhythmia, emergency medicine, genetics, hyperthyroidism, hypokalemia, kcnj18/kir2.6, management, middle east, potassium rebound, thyrotoxic periodic paralysis  \nIntroduction And Background  \nThyrotoxic periodic paralysis (TPP) is an uncommon, acute complication of thyrotoxicosis characterized by sudden flaccid muscle weakness due to a rapid intracellular shift of potassium, resulting in marked hypokalemia. Despite this relatively distinctive clinical triad, TPP frequently eludes timely recognition outside endemic settings [1] . Beyond the stereotypical young, otherwise healthy man with abrupt proximal weakness and profound hypokalemia, TPP can be misattributed to primary neurologic disease, renal potassium wasting, or toxicologic exposure. Global mobility, the rising prevalence of hyperthyroidism in diverse populations, and variable access to endocrine testing collectively argue for renewed attention to pragmatic diagnostic pathways that can be implemented in emergency departments (EDs) and acute care wards [2] . In the Middle East, where case reports document malignant arrhythmias and recurrent attacks before euthyroidism is achieved, a clinically oriented synthesis targeted to frontline clinicians is particularly warranted [3-7]. In this narrative review, we synthesize heterogeneous, predominantly case-based global and Middle Eastern literature to highlight practical bedside steps that may shorten time-to-diagnosis, standardize acute management, and reduce preventable morbidity, while acknowledging that the recommendations are derived from low-level evidence and should be interpreted as pragmatic practice sug","cbCaidAHE4FwJuLe","https://ap.wps.com/l/cbCaidAHE4FwJuLe","pdf",1677278,14,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusions\n# Introduction And Background\n# Review\n## Methods\n## Eligibility Criteria and Study Selection","[{\"question\":\"Why is thyrotoxic periodic paralysis (TPP) dangerous and easy to miss in emergency settings?\",\"answer\":\"TPP can cause acute flaccid paralysis and is associated with marked hypokalemia during thyrotoxicosis. The article notes it is often misdiagnosed in emergency departments, including when thyrotoxicosis is subtle.\"},{\"question\":\"What triggers are commonly associated with TPP episodes?\",\"answer\":\"High-carbohydrate meals, strenuous exercise, and β-agonists are described as common triggers. Middle Eastern reports are discussed as showing broadly similar clinical patterns.\"},{\"question\":\"What management steps does the review highlight to prevent recurrence?\",\"answer\":\"The review emphasizes early correction of hypokalemia, non-selective β-blockade, and definitive control of thyrotoxicosis. It also proposes an ED-focused approach that includes rapid thyroid function testing and structured potassium replacement and β-blocker protocols.\"}]","Thyrotoxic Periodic Paralysis (TPP) : A Comprehensive Review - Regional Insights from the Middle East | PDF",1790754739,35]