title: Tiratricol-induced periodic paralysis: a review of nutraceuticals affecting thyroid function.
abstract: OBJECTIVE
  To review the potential adverse effects of thyroid hormone-based nutraceuticals and describe a case of thyrotoxic periodic paralysis (TPP) after abuse of a dietary supplement containing 3,5,3'-triiodothyroacetic acid (tiratricol).
  
  
  METHODS
  We review the literature on potential dangers and therapeutic misadventures of thyroid hormone-based nutraceuticals and present the clinical, laboratory, and radiologic data of a bodybuilder in whom hypokalemic TPP developed after use of "Triax Metabolic Accelerator".
  
  
  RESULTS
  A 23-year-old white man developed lower extremity paralysis, diaphoresis, and palpitations in the setting of low serum potassium levels. Laboratory results showed suppressed thyroid-stimulating hormone, low levels of free and total thyroxine, low total triiodothyronine level, and very low 24-hour radioiodine uptake. The patient ultimately admitted to taking a supplement containing tiratricol for approximately 2 months, and hypokalemic TPP was diagnosed. He was treated with potassium supplementation and a β-adrenergic blocking agent, which completely resolved his symptoms. Results of thyroid function tests normalized or approached normal 1 week after hospitalization, and future use of dietary supplements was strongly discouraged. Despite 2 warnings by the US Food and Drug Administration, products containing tiratricol are still available for sale on the Internet.
  
  
  CONCLUSIONS
  This report illustrates both an unusual adverse effect of a nutraceutical containing tiratricol and the importance of educating our patients about the risks versus benefits of using these widely available but loosely regulated products.
authors.affiliation: North Shore Long Island Jewish Health System, Lake Success, New York.
authors.forename: Janna
authors.initials: J
authors.lastname: Cohen-Lehman
authors.forename: Marina M
authors.initials: MM
authors.lastname: Charitou
authors.forename: Irwin
authors.initials: I
authors.lastname: Klein
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D010243:Paralysis / Q000139:chemically induced*; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000187:drug effects*; D014284:Triiodothyronine / Q000009:adverse effects / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D014284:Triiodothyronine; C010642:3,3',5-triiodothyroacetic acid