• Ang Lu and Shih-Hua Lin.
• Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
• Medicine (Baltimore). 2021 Nov 24; 100 (47): e27795e27795.

RationaleThyrotoxic periodic paralysis (TPP) characterized by the triad of muscle paralysis, acute hypokalemia, and the presence of hyperthyroidism is often reported in young adults but rarely reported in age >60 year-old.Patient ConcernsTwo sexagenarian males (age 61 and 62) presenting to the emergency department with progressive muscle paralysis for hours. There was symmetrical flaccid paralysis with areflexia of lower extremities. Both of them did not have the obvious precipitating factors and take any drugs.DiagnosisTheir Wayne scores, as an objective index of symptoms and signs associated with thyrotoxicosis, were <19 (7 and 14, respectively). Their blood pressure stood 162/78 and 170/82 mm Hg, respectively. Their thyroid glands were slightly enlarged. Both of them had severe hypokalemia (1.8 and 2.0 mmol/L). Their presumptive diagnosis of mineralocorticoid excess disorders with severe potassium (K+) deficit were made. However, low urine K+ excretion and relatively normal blood acid-base status were suggestive of an intracellular shift of K+ rather than K+ deficit. Hormone studies confirmed hyperthyroidism due to Graves disease.InterventionsA smaller dose of K+ supplementation (only a total of 50 and 70 mmol K+, respectively) were prescribed for the patient.OutcomesAfter treatment, their serum K+ levels became normal with a full recovery of muscle strength.LessonsOur 2 cases highlight the fact that thyrotoxic periodic paralysis must be still kept in mind as the underlying cause of hypokalemia with paralysis and hypertension in elderly patients to avoid missing curable disorders.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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