Thyrotoxic Periodic Paralysis (TPP): A Comprehensive Review with Regional Insights from the Middle East.

BACKGROUND

Thyrotoxic periodic paralysis (TPP) is a rare but potentially life-threatening cause of acute flaccid paralysis, characterized by hypokalemia in the setting of thyrotoxicosis and often misdiagnosed in emergency departments.

METHODS

We conducted a narrative literature review of TPP in adults using major databases up to 31 October 2025, with a focus on clinical presentation, precipitants, diagnostic pitfalls, and management, and we synthesized Middle Eastern case data alongside global experience.

RESULTS

TPP typically affects younger males and may be the first manifestation of hyperthyroidism. High-carbohydrate meals, strenuous exercise, and β-agonists are common triggers. Misdiagnosis as Guillain-Barré syndrome or other neuromuscular conditions is frequent, particularly when thyrotoxicosis is subtle. Middle Eastern reports suggest similar clinical patterns but highlight delayed recognition and variable access to thyroid testing. Early correction of hypokalemia, non-selective beta (β)-blockade, and definitive control of thyrotoxicosis are essential to prevent recurrences.

CONCLUSIONS

An emergency department (ED)-focused approach that routinely considers TPP in acute flaccid paralysis, integrates rapid thyroid function testing, and follows structured potassium replacement and β-blocker protocols can reduce diagnostic delay and improve outcomes. Incorporating regional data may help tailor awareness campaigns and management pathways in Middle Eastern and other underrepresented settings.