Serum potassium was 2.2 mmol/L (3.3–5.1) and he was given i.v. In the first case, a 33-year-old Filipino gentleman presented to our emergency department (ED) with a 3-month history of recurrent proximal lower limb weakness. We present two cases of TPP with differing outcomes. Treatment of TPP includes prevention of this shift by using beta-blockade, rapid potassium replacement and treatment of the underlying hyperthyroidism. Hypokalaemia in TPP results from a massive intracellular shift of potassium induced by the thyroid hormone sensitisation of Na +/K +-ATPase ( 4). It has been reported in approximately 2% of patients with thyrotoxicosis in China and Japan ( 1, 2, 3). Thyrotoxic periodic paralysis (TPP) is a rare condition characterised by acute onset hypokalaemia and paralysis which most commonly affects men of Asian descent between the ages of 20 and 40 years ( 1, 2). These cases highlight the importance of prompt recognition of this rare life-threatening complication of Graves’ disease, especially in patients of Asian descent. He represented to the hospital on two further occasions with TPP and was advised to consider total thyroidectomy given his refractory Graves’ disease. potassium replacement and discharged home on carbimazole and propranolol. Serum potassium was 1.9 mmol/L with TFTs demonstrating Graves thyrotoxicosis. In the second case, a 22-year-old Malaysian gentleman presented to our ED with new-onset bilateral lower limb painless paralysis. He was discharged home on carbimazole and remains well controlled on long-term medical therapy. Thyroid function tests (TFTs) and thyroid antibodies were consistent with Graves thyrotoxicosis. Hypokalaemia in TPP results from a massive intracellular shift of potassium induced by the thyroid hormone sensitisation of Na +/K +-ATPase (). It has been reported in approximately 2% of patients with thyrotoxicosis in China and Japan (,, ). Thyrotoxic periodic paralysis (TPP) is a rare condition characterised by acute onset hypokalaemia and paralysis which most commonly affects men of Asian descent between the ages of 20 and 40 years (, ).
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