Piekaar Roderick S M, Kwak Aron R, Kelderman Nienke, Eustatia-Rutten Carmen F A
Rijnland Ziekenhuis, afd. Interne Geneeskunde, Leiderdorp.
Ned Tijdschr Geneeskd. 2014;158:A7835.
Thyreotoxic hypokalaemic periodic paralysis (THPP) is a rare and potentially life-threatening syndrome. It principally affects men of East-Asian origin and has rarely been described in a white person.
A 34-year-old Dutch man, suffering from Graves' disease, presented with weakness in his lower limbs. Laboratory investigation showed severe hypokalaemia (1.8 mmol/l) and increased creatinine kinase levels. An electrocardiogram showed atrial fibrillation with a prolonged QTc-interval. The patient was admitted, cardiac rhythm was monitored, and he received potassium supplements. Laboratory investigation of thyroid function showed thyrotoxicosis. The patient was treated with propranolol and thiamazol. At follow-up, thyroid function, potassium levels and muscle strength had normalized.
Hypokalaemia due to thyrotoxicosis should be considered in cases of unexplained paralysis. The treatment of THPP consists of treating for hyperthyroidism plus propranolol. Since the hypokalaemia is self-limiting, potassium supplementation is only necessary in cases of rhythm disturbances or cardiac-conduction disturbances. Despite adequate treatment, there is a risk of recurrence. Regular monitoring is indicated until euthyroidism is achieved.
甲状腺毒症性低钾周期性麻痹（THPP）是一种罕见且可能危及生命的综合征。它主要影响东亚裔男性，在白人中很少有描述。
一名34岁的荷兰男子，患有格雷夫斯病，出现下肢无力。实验室检查显示严重低钾血症（1.8 mmol/L）且肌酸激酶水平升高。心电图显示心房颤动伴QTc间期延长。患者入院，监测心律，并接受补钾治疗。甲状腺功能实验室检查显示甲状腺毒症。患者接受普萘洛尔和甲巯咪唑治疗。随访时，甲状腺功能、血钾水平和肌肉力量已恢复正常。
对于不明原因的麻痹病例，应考虑甲状腺毒症导致的低钾血症。THPP的治疗包括治疗甲亢加用普萘洛尔。由于低钾血症是自限性的，仅在出现心律紊乱或心脏传导紊乱时才需要补钾。尽管治疗充分，但仍有复发风险。在实现甲状腺功能正常之前，需定期监测。
