Hyperthyroidism paralysis

Classic beri-beri, rarely seen in the United States and Europe, except in alcoholism (P4), is endemic in the Far East because of the prevalent diet of decorticated rice (F6). It occurs in two forms wet beri-beri, characterized by edema and cardiovascular symptoms (G6), and dry beri-beri with peripheral neuritis, paralysis, and atrophy of the muscles. Conditions which may predispose to deficiency by increasing thiamine requirements are pregnancy (see section 2.4), and lactation, hyperthyroidism, malignant disease, febrile conditions, increased muscular activity, high carbohydrate diets, and parenteral administration of glucose solutions. A constant supply of thiamine is required for optimal nutrition because storage in the liver and elsewhere is limited. Thiamine is synthesized by bacteria in the intestinal tract of various animals, but this is not a dependable source for man. 

Hypokalemic periodic paralysis is a rare complication of hyperthyroidism commonly observed in Asian and Hispanic populations. It presents as recurrent proximal muscle flaccidity ranging from mild weakness to total paralysis. The paralysis may be asymmetric and usually involves muscle groups that are strenuously exercised before the attack. Cognition and sensory perception are spared, whereas deep tendon reflexes are commonly markedly diminished. Hypokalemia results from a shift of potassium from extracellular to intracellular sites. High carbohydrate loads and exercise provoke the attacks. Treatment includes correcting the hyperthyroid state, potassium administration, spironolactone to conserve potassium, and propranolol to minimize intracellular shifts. ... 

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