Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis

Yu Juei Hsu, Yuh Feng Lin, Tom Chau, Jun Ting Liou, Shi Wen Kuo, Shih Hua Lin

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Thyrotoxic periodic paralysis (TPP) commonly precedes the overt symptoms and signs of hyperthyroidism and may be misdiagnosed as other causes of paralysis (non-TPP). Because the cardiovascular system is very sensitive to elevation of thyroid hormone, we hypothesize that electrocardiographic manifestations may aid in early diagnosis of TPP. Methods: We retrospectively identified 54 patients who presented to the emergency department (ED) with hypokalemic paralysis during a 3.5-year period. Thirty-one patients had TPP and 23 patients had non-TPP, including sporadic periodic paralysis, distal renal tubular acidosis, diuretic use, licorice intoxication, primary hyperaldosteronism, and Bartter-like syndrome. Electrocardiograms during attacks were analyzed for rate, rhythm, conduction, PR interval, QRS voltage, ST segment, QT interval, U waves, and T waves. Results: There were no significant differences in age, sex distribution, and plasma K+ concentration between the TPP and non-TPP groups. Plasma phosphate was significantly lower in TPP than non-TPP. Heart rate, PR interval, and QRS voltage were significantly higher in TPP than non-TPP. Forty-five percent of TPP patients had first-degree atrioventricular block compared with 13% in the non-TPP group. There were no significant differences in QT shortening, ST depression, U wave appearance, or T wave flattening between the 2 groups. Conclusion: Relatively rapid heart rate, high QRS voltage, and first-degree AV block are important clues suggesting TPP in patients who present with hypokalemia and paralysis.

Original languageEnglish
Pages (from-to)128-132
Number of pages5
JournalAmerican Journal of the Medical Sciences
Volume326
Issue number3
DOIs
Publication statusPublished - Sep 1 2003
Externally publishedYes

Fingerprint

Paralysis
Atrioventricular Block
Heart Rate
Bartter Syndrome
Renal Tubular Acidosis
Glycyrrhiza
Sex Distribution
Hyperaldosteronism
Hypokalemia
Age Distribution
Hyperthyroidism
Cardiovascular System
Diagnostic Errors
Thyroid Hormones
Diuretics
Signs and Symptoms
Hospital Emergency Service

Keywords

  • Electrocardiography
  • Hyperthyroidism
  • Hypokalemia
  • Paralysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis. / Hsu, Yu Juei; Lin, Yuh Feng; Chau, Tom; Liou, Jun Ting; Kuo, Shi Wen; Lin, Shih Hua.

In: American Journal of the Medical Sciences, Vol. 326, No. 3, 01.09.2003, p. 128-132.

Research output: Contribution to journalArticle

Hsu, Yu Juei ; Lin, Yuh Feng ; Chau, Tom ; Liou, Jun Ting ; Kuo, Shi Wen ; Lin, Shih Hua. / Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis. In: American Journal of the Medical Sciences. 2003 ; Vol. 326, No. 3. pp. 128-132.
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AB - Background: Thyrotoxic periodic paralysis (TPP) commonly precedes the overt symptoms and signs of hyperthyroidism and may be misdiagnosed as other causes of paralysis (non-TPP). Because the cardiovascular system is very sensitive to elevation of thyroid hormone, we hypothesize that electrocardiographic manifestations may aid in early diagnosis of TPP. Methods: We retrospectively identified 54 patients who presented to the emergency department (ED) with hypokalemic paralysis during a 3.5-year period. Thirty-one patients had TPP and 23 patients had non-TPP, including sporadic periodic paralysis, distal renal tubular acidosis, diuretic use, licorice intoxication, primary hyperaldosteronism, and Bartter-like syndrome. Electrocardiograms during attacks were analyzed for rate, rhythm, conduction, PR interval, QRS voltage, ST segment, QT interval, U waves, and T waves. Results: There were no significant differences in age, sex distribution, and plasma K+ concentration between the TPP and non-TPP groups. Plasma phosphate was significantly lower in TPP than non-TPP. Heart rate, PR interval, and QRS voltage were significantly higher in TPP than non-TPP. Forty-five percent of TPP patients had first-degree atrioventricular block compared with 13% in the non-TPP group. There were no significant differences in QT shortening, ST depression, U wave appearance, or T wave flattening between the 2 groups. Conclusion: Relatively rapid heart rate, high QRS voltage, and first-degree AV block are important clues suggesting TPP in patients who present with hypokalemia and paralysis.

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