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Thyrotoxic Periodic Paralysis: Title and subTitle BreakMetabolic and Ultrastructural Studies

Forbes H. Norris, Jr., MD; Bernard J. Panner, MD; James M. Stormont, MD
[+] Author Affiliations

Submitted for publication Feb 9, 1968; accepted March 9.

Reprint requests to Institute of Medical Sciences, Pacific Medical Center, San Francisco 94115 (Dr. Norris).


Arch Neurol. 1968;19(1):88-98. doi:10.1001/archneur.1968.00480010106009
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PERIODIC paralysis is a rare complication of hyperthyroidism except in Japan1-3 and countries having many people of Japanese ancestry.4 Between 2% and 8% of hyperthyroidal Japanese suffer from periodic paralysis,3-5 and in adult males the incidence may be as high as 33%.3

Thyrotoxic periodic paralysis (TPP) resembles familial periodic paralysis (FPP) in clinical features, accentuation by exercise or carbohydrate loads, and hypokalemia.2-5 Intramuscular vacuoles, which are a notable feature of the histopathology in FPP,6 have also been found in TPP during paresis.3 This finding has recently been confirmed in an electron microscopic study.7

There are, on the other hand, important differences between TPP and FPP. The paralytic episodes in TPP generally parallel the hyperthyroidal state, and can be greatly alleviated or cured by appropriate thyroid treatment,1,3-5 while attacks of FPP are associated with a falling metabolic rate.1,8 TPP also

REFERENCES

Engel, A.G.:  Thyroid Function and Periodic Paralysis , Amer J Med 30:327-333 ( (Feb) ) 1961;.
Satoyoshi, E.; Suzuki, T.; and Abe, T.:  Periodic Paralysis , Neurology 13:24-33 ( (Jan) ) 1963;.
Satoyoshi, E., et al:  Periodic Paralysis in Hyperthyroidism , Neurology 13:746-752 ( (Sept) ) 1963;.
Okihiro, N.M., and Beddow, R.M.:  Thyrotoxic Periodic Paralysis in Hawaii , Neurology 15:253-255 ( (March) ) 1965;.
Okinaka, S., et al:  The Association of Periodic Paralysis and Hyperthyroidism in Japan , J Clin Endocr Metab 17:1454-1459 ( (Dec) ) 1957;.
Shy, G.M., et al:  Studies in Familial Periodic Paralysis , Exp Neurol 3:53-121 ( (Jan) ) 1961;.
Engel, A.G.:  Electron Microscopic Observations in Primary Hypokalemic and Thyrotoxic Periodic Paralysis , Mayo Clin Proc 41:797-808 ( (Nov) ) 1966;.
Norris, F.H.:  Some Metabolic Studies of Sporadic and Familial Periodic Paralysis , Neurology 12:208-212 ( (March) ) 1962;.
McArdle, B.:  Familial Periodic Paralysis , Brit Med Bull 12:226-229 ( (Dec) ) 1956;.
Norris, F.H.:  Status of the Segmental Innervation in Thyrotoxic Periodic Paralysis , Electroenceph Clin Neurophysiol 21:67-70 ( (July) ) 1966;.
Rowley, P.T., and Kliman, B.:  The Effect of Sodium Loading and Depletion on Muscular Strength and Aldosterone Excretion in Familial Periodic Paralysis , Amer J Med 28:376-385 ( (March) ) 1960;.
Amatuzio, D.S., et al:  Interpretation of the Rapid Intravenous Glucose Tolerance Test in Normal Individuals and in Mild Diabetes Mellitus , J Clin Invest 32:428-435 ( (May) ) 1953;.
Amatuzio, D.S., et al:  The Effect of Epinephrine, Insulin, and Hyperthyroidism on the Rapid Intravenous Glucose Tolerance Test , J Clin Invest 33:97-102 ( (Jan) ) 1954;.
Medical Research Council: Aids to the Investigation of Peripheral Nerve Injuries, London: Her Majesty's Stationery Office, 1958.
Luft, J.H.:  Improvements in Epoxy Resin Embedding Methods , J Biophys Biochem Cytol 9:409-414 ( (Feb) ) 1961;.
Reynolds, E.S.:  Use of Lead Citrate at High pH as Electron-opaque Stain in Electron Microscopy , J Cell Biol 17:208-212 ( (April) ) 1963;.
Asboe-Hansen, G.; Iverson, K.; and Wichmann, R.:  Malignant Exophthalmos , Acta Endocr 11:376-399 ( (Dec) ) 1952;.
Wolf, A.:  The Effective Use of Thyroid in Periodic Paralysis , NY State J Med 43:1951-1963 ( (Oct) ) 1943;.
Gage, P.W., and Eisenberg, R.S.:  Action Potentials Without Contraction in Frog Skeletal Muscle Fibers With Disrupted Transverse Tubules , Science 158:1702-1704 ( (Nov) ) 1967;.
Odor, D.L.; Patel, A.N.; and Pearce, L.A.:  Familial Hypokalemic Periodic Paralysis With Permanent Myopathy , J Neuropath Exp Neurol 26:98-114 ( (Jan) ) 1967;.
Pearce, G.W.: " Electron Microscopy in the Study of Muscular Dystrophy ," in Bourne, G.H., and Golarz, M.N. (eds.): Muscular Dystrophy in Man and Animals , New York: Hafner, 1963;, pp 160-191.
Pearce, G.W.:  Electron Microscopy in the Study of Muscular Dystrophy , Ann NY Acad Sci 138:138-150, 1966;.
Milhorat, A.T.; Shafiq, S.A.; and Goldstone, L.:  Changes in Muscle Structure in Dystrophic Patients, Carriers, and Normal Siblings Seen by Electron Microscopy: Correlation With Levels of Serum Creatinephosphokinase (CPK) , Ann NY Acad Sci 138:246-292, 1966;.
Engel, A.G.:  Thyrotoxic and Corticosteroid-induced Myopathies , Mayo Clinic Proc 41:785-796 ( (Nov) ) 1966;.
Dyken, M.L., and Timmons, G.D.:  Hyperkalemic Periodic Paralysis With Hypocalcemic Episode , Arch Neurol 9:508-517 ( (Nov) ) 1963;.
Crane, M.G.:  Periodic Paralysis Associated With Hyperthyroidism , Calif Med 92:285-288 ( (April) ) 1960;.
Engel, A.G.; Potter, C.S.; and Rosevear, J.W.:  Studies on Carbohydrate Metabolism and Mitochondrial Respiratory Activities in Primary Hypokalemic Periodic Paralysis , Neurology (Minneap) 17:329-337 ( (April) ) 1967;.
Spurlock, B.O.; Skinner, M.S.; and Kattine, A.A.:  A Simple Rapid Method for Staining Epoxyembedded Specimens for Light Microscopy With the Polychromatic Stain Paragon-1301 , Amer J Clin Path 46:252-258 ( (Aug) ) 1966;.

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Engel, A.G.:  Thyroid Function and Periodic Paralysis , Amer J Med 30:327-333 ( (Feb) ) 1961;.
Satoyoshi, E.; Suzuki, T.; and Abe, T.:  Periodic Paralysis , Neurology 13:24-33 ( (Jan) ) 1963;.
Satoyoshi, E., et al:  Periodic Paralysis in Hyperthyroidism , Neurology 13:746-752 ( (Sept) ) 1963;.
Okihiro, N.M., and Beddow, R.M.:  Thyrotoxic Periodic Paralysis in Hawaii , Neurology 15:253-255 ( (March) ) 1965;.
Okinaka, S., et al:  The Association of Periodic Paralysis and Hyperthyroidism in Japan , J Clin Endocr Metab 17:1454-1459 ( (Dec) ) 1957;.
Shy, G.M., et al:  Studies in Familial Periodic Paralysis , Exp Neurol 3:53-121 ( (Jan) ) 1961;.
Engel, A.G.:  Electron Microscopic Observations in Primary Hypokalemic and Thyrotoxic Periodic Paralysis , Mayo Clin Proc 41:797-808 ( (Nov) ) 1966;.
Norris, F.H.:  Some Metabolic Studies of Sporadic and Familial Periodic Paralysis , Neurology 12:208-212 ( (March) ) 1962;.
McArdle, B.:  Familial Periodic Paralysis , Brit Med Bull 12:226-229 ( (Dec) ) 1956;.
Norris, F.H.:  Status of the Segmental Innervation in Thyrotoxic Periodic Paralysis , Electroenceph Clin Neurophysiol 21:67-70 ( (July) ) 1966;.
Rowley, P.T., and Kliman, B.:  The Effect of Sodium Loading and Depletion on Muscular Strength and Aldosterone Excretion in Familial Periodic Paralysis , Amer J Med 28:376-385 ( (March) ) 1960;.
Amatuzio, D.S., et al:  Interpretation of the Rapid Intravenous Glucose Tolerance Test in Normal Individuals and in Mild Diabetes Mellitus , J Clin Invest 32:428-435 ( (May) ) 1953;.
Amatuzio, D.S., et al:  The Effect of Epinephrine, Insulin, and Hyperthyroidism on the Rapid Intravenous Glucose Tolerance Test , J Clin Invest 33:97-102 ( (Jan) ) 1954;.
Medical Research Council: Aids to the Investigation of Peripheral Nerve Injuries, London: Her Majesty's Stationery Office, 1958.
Luft, J.H.:  Improvements in Epoxy Resin Embedding Methods , J Biophys Biochem Cytol 9:409-414 ( (Feb) ) 1961;.
Reynolds, E.S.:  Use of Lead Citrate at High pH as Electron-opaque Stain in Electron Microscopy , J Cell Biol 17:208-212 ( (April) ) 1963;.
Asboe-Hansen, G.; Iverson, K.; and Wichmann, R.:  Malignant Exophthalmos , Acta Endocr 11:376-399 ( (Dec) ) 1952;.
Wolf, A.:  The Effective Use of Thyroid in Periodic Paralysis , NY State J Med 43:1951-1963 ( (Oct) ) 1943;.
Gage, P.W., and Eisenberg, R.S.:  Action Potentials Without Contraction in Frog Skeletal Muscle Fibers With Disrupted Transverse Tubules , Science 158:1702-1704 ( (Nov) ) 1967;.
Odor, D.L.; Patel, A.N.; and Pearce, L.A.:  Familial Hypokalemic Periodic Paralysis With Permanent Myopathy , J Neuropath Exp Neurol 26:98-114 ( (Jan) ) 1967;.
Pearce, G.W.: " Electron Microscopy in the Study of Muscular Dystrophy ," in Bourne, G.H., and Golarz, M.N. (eds.): Muscular Dystrophy in Man and Animals , New York: Hafner, 1963;, pp 160-191.
Pearce, G.W.:  Electron Microscopy in the Study of Muscular Dystrophy , Ann NY Acad Sci 138:138-150, 1966;.
Milhorat, A.T.; Shafiq, S.A.; and Goldstone, L.:  Changes in Muscle Structure in Dystrophic Patients, Carriers, and Normal Siblings Seen by Electron Microscopy: Correlation With Levels of Serum Creatinephosphokinase (CPK) , Ann NY Acad Sci 138:246-292, 1966;.
Engel, A.G.:  Thyrotoxic and Corticosteroid-induced Myopathies , Mayo Clinic Proc 41:785-796 ( (Nov) ) 1966;.
Dyken, M.L., and Timmons, G.D.:  Hyperkalemic Periodic Paralysis With Hypocalcemic Episode , Arch Neurol 9:508-517 ( (Nov) ) 1963;.
Crane, M.G.:  Periodic Paralysis Associated With Hyperthyroidism , Calif Med 92:285-288 ( (April) ) 1960;.
Engel, A.G.; Potter, C.S.; and Rosevear, J.W.:  Studies on Carbohydrate Metabolism and Mitochondrial Respiratory Activities in Primary Hypokalemic Periodic Paralysis , Neurology (Minneap) 17:329-337 ( (April) ) 1967;.
Spurlock, B.O.; Skinner, M.S.; and Kattine, A.A.:  A Simple Rapid Method for Staining Epoxyembedded Specimens for Light Microscopy With the Polychromatic Stain Paragon-1301 , Amer J Clin Path 46:252-258 ( (Aug) ) 1966;.

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