Ngu W S, Tymms D J
Department of Endocrinology, Wrightington, Wigan and Leigh NHS Trust, Wigan, UK.
BMJ Case Rep. 2010 Oct 21;2010:bcr0320102785. doi: 10.1136/bcr.03.2010.2785.
A healthy 35-year-old Vietnamese man presented with acute tetraparesis. He was watching television when suddenly he could not mobilise. As the weakness progressed overnight he attended the accident and emergency department. Observations were normal. He denied any pain, headache, vomiting, diarrhoea or use of laxatives or illicit drugs. Neurological examination revealed global weakness in all four limbs ranging from 0 to 3/5. Reflexes were suppressed. Examination of cranial nerves and of other systems was unremarkable. However, laboratory results showed a hypokalaemia of 2.3 (3.5-5.5 mmol/l) on admission. ECG first showed U waves and Mobitz type 1 but this resolved to sinus rhythm. On further questioning, he revealed a recent weight loss of 9 kg despite an increase in appetite. Thyroid function tests revealed free T4 57 (12-22 pmol/l) with thyroid-stimulating hormone undetectable. He was treated with potassium replacement and carbimazole and his symptoms resolved completely 8 days post-admission. The patient was diagnosed with hypokalaemic thyrotoxic periodic paralysis.
一名35岁健康的越南男子出现急性四肢轻瘫。他正在看电视时突然无法活动。随着夜间无力症状加重，他前往急诊室就诊。各项检查结果均正常。他否认有任何疼痛、头痛、呕吐、腹泻，也否认使用过泻药或违禁药物。神经系统检查显示四肢均有全身性无力，肌力从0级到3/5级。反射减弱。颅神经及其他系统检查未见异常。然而，实验室检查结果显示入院时血钾浓度为2.3（3.5 - 5.5毫摩尔/升），存在低钾血症。心电图最初显示有U波和莫氏I型房室传导阻滞，但随后恢复为窦性心律。进一步询问时，他透露尽管食欲增加，但近期体重减轻了9千克。甲状腺功能检查显示游离甲状腺素为57（12 - 22皮摩尔/升），促甲状腺激素检测不到。给予补钾及卡比马唑治疗，入院8天后他的症状完全缓解。该患者被诊断为低钾性甲状腺毒症性周期性瘫痪。
