The interesting case report by Laroia et al (1) illustrates a rare endocrine emergency associated with thyrotoxicosis. Hypokalemic periodic paralysis has been linked to thyrotoxicosis of varying etiologies. These etiologies include Graves' disease, toxic adenoma, toxic multinodular goiter, factitious thyrotoxicosis, thyrotropin-producing pituitary tumors, and lymphocytic thyroiditis. (2) Any cause of thyrotoxicosis, including overzealous thyroxine replacement, can provoke an attack of thyrotoxic periodic paralysis in susceptible patients.

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