Thyrotoxicosis and Periodic Paralysis: Improvement with Beta Blockade
Authors: MARTIN J. CONWAY
Journal: Annals of Internal Medicine (1974)

Article1 September 1974Thyrotoxicosis and Periodic Paralysis: Improvement with Beta BlockadeMARTIN J. CONWAY, M.D., F.A.C.P., J. A. SEIBEL, M.D., R. PHILIP EATON, M.D.MARTIN J. CONWAY, M.D., F.A.C.P.Search for more papers by this author, J. A. SEIBEL, M.D.Search for more papers by this author, R. PHILIP EATON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-3-332 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPeriodic paralysis associated with thyrotoxicosis was observed in three unrelated American Indian males and one white male of Russian-Jewish descent. Hypokalemia was observed in all patients on at least one occasion, and in three of the patients this coincided with an episode of paralysis. In all cases, correction of the thyrotoxic state was accompanied by resolution of the episodes of paralysis. In two patients, beta-adrenergic blockade induced with propranolol therapy resulted in marked relief of the episodes of paralysis and improvement of thyrotoxic manifestations. These observations suggest that the episodic muscle paralysis seen with thyrotoxicosis may be related to the hyperadrenergic state characteristic of this disorder. Propranolol may be an important therapeutic adjunct in the management of this form of periodic paralysis....References1. MCFADZEANYEUNG AR: Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1:451-455, 1967 CrossrefMedlineGoogle Scholar2. AUYEUNG KR: Thyrotoxic periodic paralysis. Periodic variation in the muscle calcium pump activity. Arch Neurol 26:543-546, 1972 CrossrefMedlineGoogle Scholar3. RESNICKDORMANENGEL JJW: Thyrotoxic periodic paralysis. Am J Med 47:831-836, 1969 CrossrefMedlineGoogle Scholar4. LEEMORIMOTOBRONSKY WPD: Studies of thyroid and sympathetic nervous system interrelationships. I. The blepharoptosis of myxedema. J Clin Endocrinol Metab 21: 1402-1412, 1961 CrossrefMedlineGoogle Scholar5. CANARYSCHAAFDUFFY JMB: Effects of oral and intramuscular administration of reserpine in thyrotoxicosis. N Engl J Med 257:435-442, 1957 CrossrefMedlineGoogle Scholar6. GAFFNEYBRAUNWALDKAHLER TER: Effects of guanethidine on triiodothyronine-induced hyperthyroidism in man. N Engl J Med 265:16-20, 1961 CrossrefMedlineGoogle Scholar7. LEEBRONSKYWALDSTEIN WDS: Studies of thyroid and sympathetic nervous system interrelationships. II. Effects of guanethidine on manifestations of hyperthyroidism. J Clin Endocrinol Metab 22:879-891, 1962 CrossrefMedlineGoogle Scholar8. STOUTWIENERCOX BLJ: Combined alpha and beta sympathetic blockade in hyperthyroidism. Clinical and metabolic effects. Ann Intern Med 70:963-970, 1969 LinkGoogle Scholar9. TURNERGRANVILLE-GROSSMANSMART PKJ: Effect of adrenergic receptor blockade on the tachycardia of thyrotoxicosis and anxiety state. Lancet 2:1316-1318, 1965 CrossrefMedlineGoogle Scholar10. MARSDENGIMLETTEMCALLISTER CTR: Effect of beta-adrenergic blockade on finger tremor and Achilles reflex time in anxious and thyrotoxic patients. Acta Endocrinol (Kbh) 57:353-362, 1968 CrossrefMedlineGoogle Scholar11. HEFFRONEATON WR: Thyrotoxicosis presenting as choreoathetosis. Ann Intern Med 73:425-428, 1970 LinkGoogle Scholar12. RESNICKENGELGRIGGS JWR: Acetazolamide prophylaxis in hypokalemic periodic paralysis. N Engl J Med 278:582-586, 1968 CrossrefMedlineGoogle Scholar13. ENGEL A: Thyroid function and periodic paralysis. Am J Med 30:327-333, 1961 CrossrefMedlineGoogle Scholar14. OKIHIROBEDDOW MR: Thyrotoxic periodic paralysis in Hawaii. Its predilection for the Japanese race. Neurology (Minneap) 15:252-255, 1965 CrossrefGoogle Scholar15. FELDMANGOLDBERG DW: Hyperthyroidism with periodic paralysis. Can Med Assoc J 101:667-671, 1969 Google Scholar16. CRANE M: Periodic paralysis associated with hyperthyroidism. Calif Med 92:285-288, 1960 MedlineGoogle Scholar17. JACKMANJONES RR: Hyperthyroidism and periodic paralysis. Arch Intern Med 113:657-664, 1964 CrossrefMedlineGoogle Scholar18. SCHNEIDER J: Further characterization of central effects of reserpine (Serpasil). Am J Physiol 181:64-68, 1955 CrossrefMedlineGoogle Scholar19. KOSTMAN M: Current status of propranolol hydrochloride (Inderal). JAMA 225:1380-1384, 1973 CrossrefMedlineGoogle Scholar20. SATOYOSHIMURAKAMIKOWA EKH: Periodic paralysis in hyperthyroidism. Neurology (Minneap) 13:746-752, 1963 CrossrefMedlineGoogle Scholar21. SHIZUMESHISHIBA KY: Studies on electrolyte metabolism in idiopathic and thyrotoxic periodic paralysis. Metabolism 15: 138-144, 1966 CrossrefMedlineGoogle Scholar22. GROSSMANROBINJOHNSON WNL: The enhanced myocardial contractility of thyrotoxicosis. Role of the beta adrenergic receptor. Ann Intern Med 74:869-874, 1971 LinkGoogle Scholar23. GROSSMANROBINJOHNSON WNL: Effects of beta blockade on the peripheral manifestations of thyrotoxicosis. Ibid., pp. 875-879 Google Scholar24. BOWMANRAPER WC: Adrenotropic receptors in skeletal muscle. Ann NY Acad Sci 139:741-753, 1967 CrossrefMedlineGoogle Scholar25. ELLIS S: Relation of biochemical effects of epinephrine to its muscular effects. Pharmacol Rev 11:469-479, 1959 MedlineGoogle Scholar26. BOWMANRAPER WC: The effects of adrenaline and other drugs affecting carbohydrate metabolism on contractions of the rat diaphragm. Br J Pharmacol Chemother 23:184-200, 1964 CrossrefMedlineGoogle Scholar27. LEVEY G: Catecholamine sensitivity, thyroid hormone and the heart. Am J Med 50:413-420, 1971 CrossrefGoogle Scholar28. HARRISON T: Adrenal medullary and thyroid relationships. Physiol Rev 44:161-185, 1964 CrossrefMedlineGoogle Scholar29. GOLDFEINXILELIGOODMAN ASD: The estimation of epinephrine and norepinephrine in human plasma. J Clin Endocrinol Metab 21:281-295, 1961 CrossrefMedlineGoogle Scholar30. WURTMANKOPINAXELROD RIJ: Thyroid function and the cardiac disposition of catecholamines. Endocrinology 73:63-74, 1963 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Albuquerque, New Mexico▸From the Lovelace Clinic, Albuquerque, New Mexico and the University of New Mexico School of Medicine. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1974Volume 81, Issue 3Page: 332-336KeywordsCatecholaminesThyroid Issue Published: 1 September 1974 PDF DownloadLoading ...