In addition, several other studies have demonstrated that the activity of the Na+/K+-ATPase pump is increased in thyrotoxicosis and is more exacerbated in patients with TPP. [28, 29] The hypokalemia observed in these cases is due to the increased K+influx into a cell secondary to the increase in the activity of the Na+/K+-ATPase pump and by the hyperinsulinemic response to carbohydrate intake in patients susceptible to TPP. [25, 30] Androgens also can increase the activity of the Na+/K+-ATPase pump, which explains the higher incidence of the disease in young males. [30]
According to the mechanism illustrated in the Figure 2, we believe that during the TPP crisis, the mutated Kir2.6 potassium channel retains potassium in the sarcolemma, causing hypokalemia and flaccid paralysis.