Respiratory Failure in Hyperthyroidism: Focus on Thyrotoxic Periodic Paralysis

Thyrotoxic periodic paralysis (TPP) is a rare but serious and potentially life-threatening complication of hyperthyroidism. It is typically characterized by acute flaccid muscle weakness of the lower limbs and hypokalemia. While most cases resolve with cautious potassium replacement and appropriate management of thyrotoxicosis, some progress to respiratory failure, significantly worsening the prognosis. This review examines 14 reported cases of TPP complicated by respiratory failure (published between 2004 and 2025), highlighting clinical gaps in early recognition and the atypical presentations that contributed to delayed diagnosis. Additionally, the mechanisms of respiratory compromise in thyroid storm - another thyrotoxic emergency - are discussed to provide a broader understanding of respiratory failure within the spectrum of thyrotoxic states. By analyzing these case reports, this review aims to raise awareness among clinicians of unusual presentations, emphasize the need for early recognition, and advocate for timely multidisciplinary involvement, particularly from respiratory, endocrinology, and intensive care teams, in managing such critical cases.