Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2025; 13(7): 101214
Published online Mar 6, 2025. doi: 10.12998/wjcc.v13.i7.101214
Insulin-induced severe thyrotoxic periodic paralysis: A case report
Yan-Li Wang, Jian Li
Yan-Li Wang, Jian Li, Department of Endocrinology and Metabolism, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
Author contributions: Wang YL contributed to data collection and editing of the manuscript and to the literature review; Li J contributed to discussion and drafting of the manuscript.
Informed consent statement: Informed consent was obtained to publish this article.
Conflict-of-interest statement: No authors should declare any conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Li Wang, Doctor, Master's Student, Department of Endocrinology and Metabolism, Zigong First People's Hospital, No. 42 Shangyi Hao Road, Zigong City, Sichuan Province, China, Zigong 643000, Sichuan Province, China. wylisc@yeah.net
Received: September 8, 2024
Revised: October 7, 2024
Accepted: November 19, 2024
Published online: March 6, 2025
Processing time: 77 Days and 21.8 Hours
Abstract
BACKGROUND

Thyrotoxic periodic paralysis (TPP) is an endocrine emergency caused by thyrotoxicosis, manifesting mainly as periodic myasthenia and hypokalemia, and posing a serious threat to the patient's health. Fatigue, strenuous exercise, alcohol abuse, high carbohydrate intake and insulin injections are common triggers of paralysis. This article reports a case of severe TPP induced by insulin injection, elucidates the characteristics and pathogenesis of the disease, analyses the risk factors for triggering TPP, and hopefully provides more clinical data for TPP patients.

CASE SUMMARY

A 38-year-old Asian man presented to the emergency department with a one-week history of limb weakness and worsening half-day. His medical history included poorly controlled type 2 diabetes and he had been switched to Aspart50 a week earlier. He was alert and oriented with upper extremity strength grade 3 and lower extremity strength grade 1. Emergency department tests showed hypokalemia of 1.6 mmol/L. The paramedics administered 1.5 g of potassium intravenously, followed by 4.0 g orally. Weakness in the arms and legs improved. He was referred to endocrinology where he was diagnosed with Graves' disease, with suboptimal control and insulin injections possibly causing TPP. We stopped his insulin and he was discharged with a potassium level of 4.0 mmol/L.

CONCLUSION

Insulin is a trigger for TPP and should be avoided in patients with hyperthyroidism. Early recognition and treatment of TPP is crucial, especially in patients presenting with hypokalemic periodic paralysis.

Keywords: Thyrotoxic periodic paralysis; Potassium metabolism disorders; Insulin; Triggers of paralysis; Case report

Core Tip: Thyrotoxic periodic paralysis (TPP) is a severe endocrine emergency associated with potassium metabolism disorders. We report a case of severe TPP induced by insulin injection, which is rarely reported, and our study systematically elucidates the characteristics and pathogenesis of the disease, analyses the risk factors for triggering TPP, and hopefully provides more clinical data for TPP patients.