Uncontrolled hyper thyroidism has a myriad of presentations. Classically, symptoms include weight loss, tremor, palpitations, shortness of breath, diarrhea, anxiety, and heat intolerance. A rare manifestation of hyperthyroidism is thyrotoxic periodic paralysis (TPP). Periodic paralysis is a musculoskeletal channelopathy manifested by episodes of painless muscle weakness often precipitated by heavy exercise, fasting, or high carbohydrate meals. Although classically associated with painless weakness; cramping, myalgias, and stiffness can also occur prior to the episodes as prodromal symptoms. Neurologic examination during an attack typically demonstrates proximal more than distal muscle weakness, and the upper extremities are more commonly affected than the lower extremities.1-4 Consciousness and sensation are preserved, and respiratory muscle involvement is exceedingly rare. Episodes of weakness can last from a few hours up to 72 hours with intermittent recovery between attacks. Patients most often have diminished deep tendon reflexes, but reflexes may be preserved in some cases. We present a case of TPP, discuss the differential diagnosis of periodic paralysis, and review the pathophysiology and management of TPP.