Thyrotoxic periodic paralysis involves attacks of muscle weakness or paralysis alternating with periods of normal muscle function. Attacks usually begin after symptoms of hyperthyroidism have developed.

The frequency of attacks varies from daily to yearly. Episodes of muscle weakness may last for a few hours or several days.

Symptoms include:

• Difficulty breathing (rare)
• Speech difficulty (rare)
• Swallowing difficulty (rare)
• Vision changes (rare)
• Weakness/paralysis
  • Comes and goes
  • Lasts for up to several days
  • More common in legs than arms
  • Most common in shoulders and hips
  • Triggered by heavy, high-carbohydrate, high-salt meals
  • Triggered by rest after exercise

People are alert during attacks. Normal strength returns between attacks.

Symptoms of hyperthyroidism:

• Excessive sweating (diaphoresis)
• Fast heart rate
• Fatigue
• Headache
• Heat intolerance
• Increased appetite
• Insomnia
• Sensation of feeling the heart beat (palpitations)
• Skin changes: moist, warm, thin, pale (occasionally)
• Tremors
• Weight loss

The health care provider may suspect thyrotoxic periodic paralysis based on:

• Abnormal thyroid hormone levels
• A family history of the disorder
• Low potassium levels during attacks
• Symptoms that come and go in episodes

Diagnosis involves ruling out disorders associated with low potassium.

The health care provider may attempt to trigger an attack by giving you insulin and glucose (which reduces potassium levels) or thyroid hormone.

During an attack, there may be the following signs:

• Decreased or no reflexes
• Heart arrhythmias
• Low potassium in the bloodstream (serum potassium levels are normal between attacks)
• Weakness, especially in the muscles of the arms and legs and occasionally in the muscles of the eyes. The muscles involved in breathing and swallowing can sometimes be affected, and this can be fatal. Muscle strength is normal between attacks at first. However, repeated attacks may eventually cause worsening and persistent muscle weakness.

Between attacks, examination is normal. Or, there may be signs of hyperthyroidism, such as an enlarged thyroid.

Hyperthyroidism is confirmed by abnormal results on the following tests:

• High thyroid hormone levels (T3 or T4)
• Low serum TSH (thyroid stimulating hormone) levels

Other test results:

• Abnormal ECG (electrocardiogram) during attacks
• Abnormal EMG (electromyogram) during attacks
• Low serum potassium during attacks, but normal between attacks

A muscle biopsy may occasionally show abnormalities.