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Thyrotoxic Periodic Paralysis With Ventricular Fibrillation

Thyrotoxic Periodic Paralysis With Ventricular Fibrillation Abstract • Electrocardiographic conduction disturbances and nonspecific interval changes are not uncommon during hypokalemic periodic paralysis. Although premature ventricular contractions may occur during the paretic episodes associated with hyperkalemic, normokalemic, and hypokalemic periodic paralysis, ventricular tachycardia is rare; to my knowledge, ventricular fibrillation has not been previously reported. In 1977 a 40-year-old man of Puerto Rican descent was resuscitated from ventricular fibrillation and subsequently received a diagnosis of thyrotoxic hypokalemic periodic paralysis. Following thyroid suppression the patient has been asymptomatic; ambulatory ECG monitor, maximal exercise stress test, and echocardiograms have been normal. This case documents the occurrence of ventricular fibrillation in thyrotoxic periodic paralysis. (Arch Intern Med 1982;142:1362-1364) References 1. Pearson CM, Kalyanaraman K: The periodic paralyses , in Stanbury JB, Wyngaarden JB, Fredrickson DS (eds): The Metabolic Basis of Inherited Disease . New York, McGraw-Hill Book Co, 1972, pp 1181-1203. 2. Stewart HJ, Smith JJ, Milhorat AT: Electrocardiographic and serum potassium changes in familial periodic paralysis. Am J Med Sci 1940;199:789-795.Crossref 3. Stoll B, Nisnewitz S: Electrocardiographic studies in a case of periodic paralysis. Arch Intern Med 1941;67:755-761.Crossref 4. McFadzean AJS, Yeung R: Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1967;1:451-455.Crossref 5. Ee B, Cheah JS: Electrocardiographic changes in thyrotoxic periodic paralysis. J Electrocardiol 1979;12:263-279.Crossref 6. Shah N, Kussman MJ, Tulgan H: Familial periodic paralysis and hyperthyroidism. NY State J Med 1979;79:1770-1771. 7. Gass H, Cherkasky M, Savitsky N: Potassium and periodic paralysis: A metabolic study and physiological considerations. Medicine 1949;27:105-137.Crossref 8. Shires RS: Hypokalemic periodic paralysis with arrhythmia. J Fam Pract 1978;6:63-66. 9. Levitt LP, Rose LI, Dawson DM: Hypokalemic periodic paralysis with arrhythmia. N Engl J Med 1972;286:253-254.Crossref 10. Klein R, Ganelin R, Marks JF, et al: Periodic paralysis with cardiac arrhythmia. J Pediatr 1963;62:371-385.Crossref 11. Lisak RP, Lebeau J, Tucker S, et al: Hyperkalemic periodic paralysis and cardiac arrhythmia. Neurology 1972;22:810-815.Crossref 12. Gould RJ, Steeg CN, Penn AS, et al: Potentially fatal ventricular dysrhythmias and periodic paralysis, abstracted. Ann Neurol 1981;10:86. 13. Charness ME, Johns RJ: Hypokalemic periodic paralysis. Johns Hopkins Med J 1978;143:148-153. 14. Wei JY, Genecin A, Greene HL, et al: Coronary spasm with ventricular fibrillation during thyrotoxicosis: Response to attaining euthyroid state. Am J Cardiol 1979;43:335-339.Crossref 15. Channick BJ, Adlin EV, Marks AD, et al: Hyperthyroidism and mitral-valve prolapse. N Engl J Med 1981;305:497-500.Crossref 16. Kramer LD, Cole JP, Messenger JC, et al: Cardiac dysfunction in a patient with familial hypokalemic periodic paralysis. Chest 1979;75:189-192.Crossref 17. Davidson S, Surawicz B: Ectopic beats and atrioventricular conduction disturbances in patients with hypopotassemia. Arch Intern Med 1967;120:280-285.Crossref 18. Bellet S, Steiger WA, Nadler CS, et al: Electrocardiographic patterns in hypopotassemia: Observations on 79 patients. Am J Med Sci 1950;219:542-558.Crossref 19. Wolferth CC, McMillan TM: Paroxysmal ventricular tachycardia. Arch Intern Med 1923;31:191-199.Crossref 20. Parker JLW, Lawson DH: Death from thyrotoxicosis. Lancet 1973;2:894-895.Crossref 21. Hoffman I, Lowrey RD: The electrocardiogram in thyrotoxicosis. Am J Cardiol 1960;6:893-904.Crossref 22. Blizzard JJ, Rupp JJ: Prolongation of the P-R interval as a manifestation of thyrotoxicosis. JAMA 1960;173:1845.Crossref 23. Rosenblum R, Delman AJ: First-degree heart block associated with thyrotoxicosis. Arch Intern Med 1963;112:488-490.Crossref 24. Campus S, Rappelli A, Malavasi A, et al: Heart block and hyperthyroidism: Report of two cases. Arch Intern Med 1975;135:1091-1095.Crossref 25. Linder MA: Periodic paralysis associated with hyperthyroidism: Report of three cases. Ann Intern Med 1955;43:241-254.Crossref 26. Jackman RL, Jones RE: Hyperthyroidism and periodic paralysis. Arch Intern Med 1964;113:657-664.Crossref 27. Conway MJ, Seibel JA, Eaton RP: Thyrotoxicosis and periodic paralysis: Improvement with beta blockade. Ann Intern Med 1974;81:332-336.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Thyrotoxic Periodic Paralysis With Ventricular Fibrillation

Archives of Internal Medicine , Volume 142 (7) – Jul 1, 1982

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340200130024
Publisher site
See Article on Publisher Site

Abstract

Abstract • Electrocardiographic conduction disturbances and nonspecific interval changes are not uncommon during hypokalemic periodic paralysis. Although premature ventricular contractions may occur during the paretic episodes associated with hyperkalemic, normokalemic, and hypokalemic periodic paralysis, ventricular tachycardia is rare; to my knowledge, ventricular fibrillation has not been previously reported. In 1977 a 40-year-old man of Puerto Rican descent was resuscitated from ventricular fibrillation and subsequently received a diagnosis of thyrotoxic hypokalemic periodic paralysis. Following thyroid suppression the patient has been asymptomatic; ambulatory ECG monitor, maximal exercise stress test, and echocardiograms have been normal. This case documents the occurrence of ventricular fibrillation in thyrotoxic periodic paralysis. (Arch Intern Med 1982;142:1362-1364) References 1. Pearson CM, Kalyanaraman K: The periodic paralyses , in Stanbury JB, Wyngaarden JB, Fredrickson DS (eds): The Metabolic Basis of Inherited Disease . New York, McGraw-Hill Book Co, 1972, pp 1181-1203. 2. Stewart HJ, Smith JJ, Milhorat AT: Electrocardiographic and serum potassium changes in familial periodic paralysis. Am J Med Sci 1940;199:789-795.Crossref 3. Stoll B, Nisnewitz S: Electrocardiographic studies in a case of periodic paralysis. Arch Intern Med 1941;67:755-761.Crossref 4. McFadzean AJS, Yeung R: Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1967;1:451-455.Crossref 5. Ee B, Cheah JS: Electrocardiographic changes in thyrotoxic periodic paralysis. J Electrocardiol 1979;12:263-279.Crossref 6. Shah N, Kussman MJ, Tulgan H: Familial periodic paralysis and hyperthyroidism. NY State J Med 1979;79:1770-1771. 7. Gass H, Cherkasky M, Savitsky N: Potassium and periodic paralysis: A metabolic study and physiological considerations. Medicine 1949;27:105-137.Crossref 8. Shires RS: Hypokalemic periodic paralysis with arrhythmia. J Fam Pract 1978;6:63-66. 9. Levitt LP, Rose LI, Dawson DM: Hypokalemic periodic paralysis with arrhythmia. N Engl J Med 1972;286:253-254.Crossref 10. Klein R, Ganelin R, Marks JF, et al: Periodic paralysis with cardiac arrhythmia. J Pediatr 1963;62:371-385.Crossref 11. Lisak RP, Lebeau J, Tucker S, et al: Hyperkalemic periodic paralysis and cardiac arrhythmia. Neurology 1972;22:810-815.Crossref 12. Gould RJ, Steeg CN, Penn AS, et al: Potentially fatal ventricular dysrhythmias and periodic paralysis, abstracted. Ann Neurol 1981;10:86. 13. Charness ME, Johns RJ: Hypokalemic periodic paralysis. Johns Hopkins Med J 1978;143:148-153. 14. Wei JY, Genecin A, Greene HL, et al: Coronary spasm with ventricular fibrillation during thyrotoxicosis: Response to attaining euthyroid state. Am J Cardiol 1979;43:335-339.Crossref 15. Channick BJ, Adlin EV, Marks AD, et al: Hyperthyroidism and mitral-valve prolapse. N Engl J Med 1981;305:497-500.Crossref 16. Kramer LD, Cole JP, Messenger JC, et al: Cardiac dysfunction in a patient with familial hypokalemic periodic paralysis. Chest 1979;75:189-192.Crossref 17. Davidson S, Surawicz B: Ectopic beats and atrioventricular conduction disturbances in patients with hypopotassemia. Arch Intern Med 1967;120:280-285.Crossref 18. Bellet S, Steiger WA, Nadler CS, et al: Electrocardiographic patterns in hypopotassemia: Observations on 79 patients. Am J Med Sci 1950;219:542-558.Crossref 19. Wolferth CC, McMillan TM: Paroxysmal ventricular tachycardia. Arch Intern Med 1923;31:191-199.Crossref 20. Parker JLW, Lawson DH: Death from thyrotoxicosis. Lancet 1973;2:894-895.Crossref 21. Hoffman I, Lowrey RD: The electrocardiogram in thyrotoxicosis. Am J Cardiol 1960;6:893-904.Crossref 22. Blizzard JJ, Rupp JJ: Prolongation of the P-R interval as a manifestation of thyrotoxicosis. JAMA 1960;173:1845.Crossref 23. Rosenblum R, Delman AJ: First-degree heart block associated with thyrotoxicosis. Arch Intern Med 1963;112:488-490.Crossref 24. Campus S, Rappelli A, Malavasi A, et al: Heart block and hyperthyroidism: Report of two cases. Arch Intern Med 1975;135:1091-1095.Crossref 25. Linder MA: Periodic paralysis associated with hyperthyroidism: Report of three cases. Ann Intern Med 1955;43:241-254.Crossref 26. Jackman RL, Jones RE: Hyperthyroidism and periodic paralysis. Arch Intern Med 1964;113:657-664.Crossref 27. Conway MJ, Seibel JA, Eaton RP: Thyrotoxicosis and periodic paralysis: Improvement with beta blockade. Ann Intern Med 1974;81:332-336.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1982

References