{
  "abstract": "Thyrotoxic periodic paralysis is a rare but potentially life‐threatening complication of thyrotoxicosis characterised by hypokalaemia‐induced flaccid paralysis due to an intracellular potassium shift rather than total body depletion. We report a male in his early 40s of Filipino origin who awoke with acute bilateral lower‐limb weakness after he had consumed a large carbohydrate meal and performed strenuous exercise within the preceding 12 hours. Venous blood gas was normal; initial serum potassium was 1.7 mmol/L with phosphate 1.07 mmol/L. The ECG showed sinus tachycardia, first‐degree atrioventricular block and prominent U‐waves with QTc 388 ms. Urine potassium/creatinine ratio was 1.7 mmol/mmol (expected <2.0 in hypokalaemia), indicating appropriate renal conservation. A point‐of‐care thyroid panel did not include thyroid-stimulating hormone (TSH); the laboratory TSH was reported later as suppressed (0.001 mIU/L) with elevated FT4/FT3. There was no diuretic, insulin or β‐agonist use. The patient received potassium chloride totalling 80 mEq (≤10 mEq/hour peripherally with continuous ECG monitoring) with serum potassium checks every 1–2 hour, and supplementation was stopped once K+ reached 4.0 mmol/L; propranolol 40 mg orally every 8 hours and methimazole 10 mg orally every 8 hours were started. Muscle strength normalised within 24 hours. This case underscores the diagnostic triad of hypokalaemia without an acid–base disorder, appropriate renal K+ conservation and characteristic ECG changes, and highlights pragmatic dosing/monitoring plus the need for definitive control of thyrotoxicosis to prevent recurrence.",
  "authors": [
    {
      "affiliations": [
        "Internal medicine department, Nephrology section, Ad diriyah hospital, Third riyadh health cluster, Riyadh, Saudi Arabia"
      ],
      "name": "Fahad S Alrashedi"
    },
    {
      "affiliations": [
        "Internal Medicine, Riyadh Third Health Cluster, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Raghad A Alonazi"
    }
  ],
  "title": "Thyrotoxic periodic paralysis: diagnostic and management considerations",
  "uid": "3c1c4b9c-91f4-542b-aab3-bc45b32261dc"
}