When no other heart defects are present it is called simple d-TGA; when other defects are present it is called complex d-TGA.Although it may seem counterintuitive, complex d-TGA presents better chance of survival and less developmental risks than simple d-TGA, as well as usually requiring fewer invasive palliative procedures. This is because the left-to-right and bidirectional shunting caused by the defects common to complex d-TGA allow a higher amount of oxygen-rich blood to enter the systemic circulation. However, complex d-TGA may cause a very slight increase to length and risk of the corrective surgery, as most or all other heart defects will normally be repaired at the same time, and the heart becomes "irritated" the more it is manipulated. Treatment
Life-saving heart surgery is always required. If the diagnosis is made in a standard hospital or other clinical facility, the baby will be transferred to a childrens hospital, if such facilities are available, for specialized paediatric treatment and equipment. The patient will require constant monitoring and care in an intensive care unit (ICU). Palliative
Palliative treatment is normally administered prior to corrective surgery in order to reduce the symptoms of d-TGA (and any other complications), giving the newborn or infant a better chance of surviving the surgery.
Subsequent attacks may be prevented by avoiding known precipitants, such as high salt or carbohydrate intake, until the thyroid disease has been adequately treated.Treatment of the thyroid disease usually leads to resolution of the paralytic attacks. Depending on the nature of the disease, the treatment may consist of thyrostatics (drugs that reduce production of thyroid hormone), radioiodine, or occasionally thyroid surgery. Epidemiology
TPP occurs predominantly in males of Chinese, Japanese, Vietnamese, Filipino, and Korean descent, as well as Thais, with much lower rates in people of other ethnicities. In Chinese and Japanese people with hyperthyroidism, 1.8–1.9% experience TPP. This is in contrast to North America, where studies report a rate of 0.1–0.2%. Native Americans, who share a genetic background with East Asians, are at an increased risk.The typical age of onset is 20–40. It is unknown why males are predominantly affected, with rates in males being 17- to 70-fold those in females, despite thyroid overactivity being much more common in women. History
After several case reports in the 18th and 19th centuries, periodic paralysis was first described in full by the German neurologist Carl Friedrich Otto Westphal (1833–1890) in 1885. In 1926 the Japanese physician Tetsushiro Shinosaki, from Fukuoka, observed the high rate of thyroid disease in Japanese people with periodic paralysis. The first English-language report, in 1931, originated from Dunlap and Kepler, physicians at the Mayo Clinic; they described the condition in a patient with features of Graves disease. In 1937 periodic paralysis was linked with hypokalemia, as well as precipitation of attacks with glucose and insulin.