Recurrent Thyrotoxic Periodic Paralysis Precipitated by Alcohol: A Case Report of Diagnostic Delay in a Young Male With Graves' Disease.

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by acute weakness and hypokalemia due to intracellular potassium shift. Clinical management of TPP consists of cautious potassium replacement, non-selective β-blockade, and prompt treatment of the underlying thyrotoxicosis. Definitive control of hyperthyroidism, combined with avoidance of known precipitants, is essential to prevent recurrent attacks. Failure to recognize the syndrome can result in repeated admissions, unnecessary evaluations, and life-threatening complications. We report the case of a 30-year-old Samoan man with Graves' disease who experienced recurrent episodes of paralysis over several months before the correct diagnosis was established. His initial presentations with severe hypokalemia and weakness were attributed to gastrointestinal and spinal disease, leading to repeated misdiagnoses despite multiple admissions. Alcohol intake, a less common but clinically important trigger, frequently precipitated his episodes; despite counseling, he was unable to achieve complete abstinence. He ultimately developed paralysis complicated by cardiac arrest, after which thyroid testing confirmed Graves' disease and TPP. Despite medical therapy, relapses continued due to lack of definitive thyroid treatment, intermittent methimazole lapses, ongoing alcohol use, and barriers to specialty follow-up. This case underscores the diagnostic challenges of TPP, the importance of recognizing it in Asian and Latino populations where prevalence is higher, and the need for early thyroid evaluation in patients with recurrent hypokalemic paralysis to prevent fatal outcomes.