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Thyrotoxic periodic paralysis (TPP) attacks are characterized as recurrent, transient episodes of muscle weakness that range from mild weakness to complete flaccid paralysis.
In this case, we report the presence of 3 distinct arrhythmias in a single patient as his potassium levelchanged during an episode of acute TPP. A 29-year-old Asian male presented to the emergency department (ED) with symmetric paralysis of his lower extremities and weakness of his upper extremities that developed overnight.
On further history, it was discovered that over the preceding 4 months the patient had clinical features of TPP that had been subtle, with reports of transient lower extremity weakness occurring that resolved without medical intervention.
On physical exam, the patient had symmetrical weakness and was unable to move his legs, but able to move his upper body, with sensation still intact.
The development of this 2:1 AV block coincided with increased weakness of more proximal muscles and decrease in reflexes. Our patient exhibited numerous ECG changes due to hypokalemia secondary to thyrotoxicosis, with associated thyrotoxic periodic paralysis. Address for Correspondence: Sarah Lopez, MD, MBA, LAC+USC Medical Center, Department of Emergency Medicine, 1200 N.


Our PhilosophyEmergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions.
Episodes of weakness are accompanied by hypokalemia, which left untreated can lead to life-threatening arrhythmias (6).
He had been recently diagnosed with hyperthyroidism 10 days prior, after presenting with 4 months of palpitations, muscle pain, cramping, and stiffness.
However, the patient’s airway was never compromised because his respiratory muscles were always intact.
Symptoms resolved, along with the seen ECG changes, with cautious potassium repletion and control of the underlying thyrotoxicosis. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. In this case study, we followed a patient’s potassium levels analyzing how they correlate with electrocardiogram changes seen while treating his hypokalemia and ultimately his paralysis.
The paralytic attack was aborted with a combination of cautious potassium replacement, methimazole and parenteral propranolol.


This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. After resolution of his original symptoms, he stopped taking the medications and presented to the ED with complete paralysis of his lower extremities. The initial electrocardiogram (ECG) showed 1st degree heart block with prominent U waves (Figure 1). The patient received initial doses of potassium chloride 10 mEq intravenously and 40 mEq orally.
The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health. Subsequently, the PR interval was noted to shorten and the rhythm returned to normal sinus (Figure 3).



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