Thyrotoxic Periodic Paralysis: Case Reports and an Up-to-Date Review of the Literature

Table 1

Triggers of periodic paralysis attacks.

Triggers	Examples	Notes
High glycaemic index foods	Sweetened drinks, pasta, certain fruits, white bread, certain cereals and fruits, for example, watermelon, rice, potatoes	High glycaemic index foods promote release higher insulin levels
Salt/high sodium intake	High-salt-containing foods	Promotes diuresis and loss of potassium
Stresses	Infection, psychological, surgery	Release of catecholamines which can activate Na/K/ATPase pump
Ambient temperature	Cold weather
Physical activity	Rest after significant exertion	Weakness maybe apparent first thing in the morning
Gastrointestinal	Diarrhoea	Loss of potassium
Drugs	Acetazolamide, oestrogen, diuretics, laxatives, liquorice, cortisol, aminoglycosides, acrolides, fluoroquinolones	Listed antibiotics adversely affect neuromuscular transmission
		Liquorice and cortisol promote potassium excretion
		Oestrogen can increase insulin resistance