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Who is most at risk for thyrotoxic periodic paralysis?
GaleEncyofNeuroDis
is very rare and occurs mostly in young adult males of Asian ancestry around the third decade.
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What gender has a greater genetic risk for hyperkalemic periodic paralysis?
The gene for hyperkalemic PP affects virtually all who inherit it, with no difference in male-vs.-female expression.
What sex is more at risk for hypokalemic periodic paralysis?
The gene for hypokalemic PP is present equally in both sexes, but leads to noticeable symptoms more often in men than in women.
Thyrotoxic periodic paralysis?
DefinitionThyrotoxic periodic paralysis is a condition in which there are episodes of muscle weakness in people with high levels of thyroid hormone (hyperthyroidism, thyrotoxicosis).Alternative NamesPeriodic paralysis - thyrotoxicCauses, incidence, and risk factorsThyrotoxic periodic paralysis is a rare condition that occurs only in people with high thyroid hormone levels (thyrotoxicosis). It is seen most commonly in Asian men.There is a similar disorder, hypokalemic periodic paralysis (familial periodic paralysis). This is an inherited condition and does not have high thyroid levels.Risk factors include a family history of periodic paralysis and hyperthyroidism.SymptomsThyrotoxic 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 goesLasts for up to several daysMore common in legs than armsMost common in shoulders and hipsTriggered by heavy, high-carbohydrate, high-salt mealsTriggered by rest after exercisePeople are alert during attacks. Normal strength returns between attacks.Symptoms of hyperthyroidism:Excessive sweating (diaphoresis)Fast heart rateFatigueHeadacheHeat intoleranceIncreased appetiteInsomniaSensation of feeling the heart beat (palpitations)Skin changes: moist, warm, thin, pale (occasionally)TremorsWeight lossSigns and testsThe health care provider may suspect thyrotoxic periodic paralysis based on:Abnormal thyroid hormone levelsA family history of the disorderLow potassium levels during attacksSymptoms that come and go in episodesDiagnosis 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 reflexesHeart arrhythmiasLow 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) levelsOther test results:Abnormal ECG(electrocardiogram) during attacksAbnormal EMG(electromyogram) during attacksLow serum potassium during attacks, but normal between attacksA muscle biopsymay occasionally show abnormalities.TreatmentThe best treatment is to quickly reduce thyroid hormone levels. Potassium should also be given during the attack, preferably by mouth. If weakness is severe, intravenous potassium may be needed. (Note: intravenous potassium should be given only if kidney function is normal and the patient is monitored in the hospital.)Weakness that involves the muscles used for breathing or swallowing is an emergency. Patients must be taken to a hospital. Dangerous heart arrhythmias may also occur during attacks.Your health care provider may recommend that you eat a diet low in carbohydrates and salt to prevent attacks. Medications called beta blockers may reduce the number and severity of attacks while hyperthyroidism is brought under control.Acetazolamide is effective in preventing attacks in people with familial periodic paralysis. It is usually not effective with thyrotoxic periodic paralysis.Expectations (prognosis)Chronic attacks will eventually lead to muscle weakness that persists even between attacks. Thyrotoxic periodic paralysis responds well to treatment. Treating hyperthyroidism will prevent attacks and may even reverse muscle weakness.ComplicationsDifficulty breathing, speaking, or swallowing during attacks (rare)Heart arrhythmias during attacksMuscle weakness that gets worse over timeCalling your health care providerGo to the emergency room or call the local emergency number (such as 911) if you have periods of muscle weakness. This is especially important if you have a family history of periodic paralysis or thyroid disorders.Emergency symptoms include:Difficulty breathing, speaking, or swallowingFaintingPreventionGenetic counseling may be advised. Treating the thyroid disorder prevents attacks of weakness.
What types of people are most at risk for bedsores?
records show that two thirds of all bedsores occur in people over age 70. People who are neurologically impaired, such as those with spinal injuries or paralysis, are also at high risk.
What are risks of spinal instrumentation?
Spinal instrumentation carries a significant risk of nerve damage and paralysis.
Is a love of soccer worth the risk of paralysis?
If you love it, then yes. If you love something strong enough, you will risk a lot of things for it. In everything you do, there is always risk involved. You might as well love something and risk it all.
What is the potentially fatal paralysis of skeletal muscles resulting from ingestion of botulinum toxin?
Ingesting botulinum toxin can cause Botulism, which has the risk of causing potentially fatal paralysis. Infants under 1 or those with severely depressed immune systems should not eat honey due to the risk of being exposed to botulinum spores in the honey.
Can wisdom teeth paralyze your face?
With the bottom wisdom teeth, this is a risk. The risk is dependent on how close the root tips are to the nerves, how curved the roots are, and how involved the extraction will get in terms of oral surgery. Your dentist or oral surgeon will determine how at risk you are for facial paralysis.
What are the risks of spinal instrumentation?
Spinal instrumentation carries a significant risk of nerve damage and paralysis. there is a risk of infection or an inflammatory reaction due to the presence of the foreign material in the body. the instrumentation may move or break.
What risks are associated with disk removal?
The most common risk of the surgery is infection.Rarely, the surgery damages nerves in the lower back or major blood vessels in front of the disk. Occasionally, there may be some residual paralysis of a leg or bladder muscle.
What risks are associated with stapedectomy?
The most serious risk is an increased hearing loss, which occurs in about one percent. Less common complications include: temporary change in taste. perforated eardrum. temporary facial nerve paralysis. ringing in the ears. vertigo.
Hypokalemic periodic paralysis?
DefinitionHypokalemic periodic paralysis is an inherited disorder that causes occasional episodes of muscle weakness.It is one of a group of genetic disorders that includes hyperkalemic periodic paralysis and thyrotoxic periodic paralysis.Alternative NamesPeriodic paralysis - hypokalemicCauses, incidence, and risk factorsHypokalemic periodic paralysis is a condition in which a person has episodes of muscle weakness and sometimes severe paralysis.The condition is congenital, which means it is present from birth. In most cases, it is passed down through families (inherited) as an autosomal dominant disorder. That means only one parent needs to pass the gene related to this condition on to you in order for you to be affected.Occasionally, the condition may be the result of a genetic problem that is not inherited.Unlike other forms of periodic paralysis, persons with congenital hypokalemic periodic paralysis have normal thyroid function and very low blood levels of potassium during episodes of weakness. This results from potassium moving from the blood into muscle cells in an abnormal way.Risks include having other family members with periodic paralysis. The risk is slightly higher in Asian men who also have thyroid disorders.Disorders that cause intermittent episodes of paralysis as their primary effect are uncommon. Hypokalemic periodic paralysis occurs in approximately 1 out of 100,000 people.SymptomsThe disorder involves attacks of muscle weakness or loss of muscle movement (paralysis) that come and go. Initially, there is normal muscle strength between attacks.Attacks usually begin in adolescence, but they can occur before age 10. Attacks that do not begin until adulthood are rare in people with hypokalemic periodic paralysis and are usually caused by other disorders.How often the attacks occur varies. Some people have attacks every day, while others have them once a year. Episodes of muscle weakness usually last between a few hours and a day.The weakness or paralysis:Most commonly is located at the shoulders and hipsMay also affect the arms, legs, muscles of the eyes, and muscles that help you breathe and swallowOccurs intermittentlyMost commonly occurs on awakeningMost commonly occurs after sleep or restIs rare during exercise, but may be triggered by rest after exerciseMay be triggered by heavy, high-carbohydrate, high-salt meals or alcohol consumptionUsually lasts 3 - 24 hoursOther symptoms may include:Eyelid myotonia (a condition in which after opening and closing the eyes, the patient cannot open them for a short time)Note: The patient's thinking remains alert during attacks.Signs and testsBetween attacks, a physical examination shows nothing abnormal. Before an attack, there may be leg stiffness or heaviness in the legs.During an attack of muscle weakness, the blood potassium level is low. This confirms the diagnosis. There is no decrease in total body potassium, and blood potassium levels are normal between attacks.During an attack, muscle reflexes may be decreased or absent, and muscles go limp rather than staying stiff. The muscle groups near the body, such as shoulders and hips, are involved more often than the arms and legs.An ECG or heart tracing may be abnormal during attacks.An EMG or muscle tracing is usually normal between attacks and abnormal during attacks.A muscle biopsymay show abnormalities.TreatmentMuscle weakness that involves the breathing or swallowing muscles is an emergency situation. Dangerous heart arrhythmias may also occur during attacks.The goals of treatment are relief of symptoms and prevention of further attacks.Potassium that is given during an attack may stop the attack. It is preferred that potassium be given by mouth, but if weakness is severe, potassium may need to be given through a vein (IV). Note: Potassium, especially intravenous potassium, should be given with caution, especially in individuals with kidney disease.Taking potassium supplements will not prevent attacks.Avoiding alcohol and eating a low-carbohydrate diet may help.A medicine called acetazolamide prevents attacks in many cases. If you take this medicine, your doctor may tell you to also take potassium supplements because acetazolamide may cause your body to lose potassium.Triamterene or spironolactone may help to prevent attacks in people who do not respond to acetazolamide.Expectations (prognosis)Hypokalemic periodic paralysis responds well to treatment. Treatment may prevent, and even reverse, progressive muscle weakness. Although muscle strength is initially normal between attacks, repeated attacks may eventually cause worsening and permanent muscle weakness between attacks.ComplicationsKidney stones(a side effect of acetazolamide)Heart arrhythmias during attacksDifficulty breathing, speaking, or swallowing during attacks (rare)Progressive muscle weaknessCalling your health care providerCall your health care provider if you have intermittent muscle weakness, particularly if there is a family history of periodic paralysis.Go to the emergency room or call the local emergency number (such as 911) if you faint or have difficulty breathing, speaking, or swallowing. These are emergency symptoms.PreventionHypokalemic periodic paralysis cannot be prevented. Because it can be inherited, genetic counseling may be advised for couples at risk for the disorder.Treatment prevents attacks of weakness. Before an attack, there may be leg stiffness or heaviness in the legs. Performing mild exercise when these symptoms start may help prevent a full-blown attack.ReferencesBarohn RJ. Muscle diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 447.
