Thyrotoxic periodic paralysis presenting with ventricular storm

Thyrotoxic periodic paralysis (TPP) is a rare accompaniment to hyperthyroidism in western populations. Severe hypokalemia with resultant muscle weakness and arrhythmias are frequently precipitated by acute stressors or carbohydrate meals from catecholamine release and insulin release, respectively. Ventricular arrhythmia, during the hypokalemic events, usually terminates easily with standard anti-arrhythmic treatment. This report describes a case of TPP complicated by ventricular storm/incessant ventricular tachycardia (VT) with subsequent cardiac arrest. A systematic review of TPP and ventricular storm was reviewed for similar cases and to help elucidate explanations for the underlying pathophysiology that may have lead to this clinical presentation. The management differences in the TPP patient are highlighted to distinguish them from conventional familial hypokalemic periodic paralysis therapy. Additionally, a brief review of ventricular storm and its initial management is included.