Tariq Mohammad, Peshin Rohit, Ellis Oliver, Grover Karan
Department of Rheumatology, Nobles Hospital, Douglas, Isle of Man, UK.
Department of Medicine, Nobles Hospital, Douglas, Isle of Man, UK.
BMJ Case Rep. 2015 Jan 7;2015:bcr2014206872. doi: 10.1136/bcr-2014-206872.
Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8 mEq/L (normal range 3.5-5), free T4 of 29.2 pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of <0.01 mIU/L (normal range 0.35-4.94). Random urinary potassium was 8.8 mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24 h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic.
周期性甲状腺毒症性麻痹是一种遗传性疾病，在西方和白种人中较为罕见。甲状腺毒症，尤其是在西方医院，是突发性麻痹的一个容易被忽视的原因。我们报告一例40岁男性病例，该患者某天早晨醒来后无法站立。他双侧下肢弛缓性无力，肌力为0/5，反射减弱，足底反射可疑；上肢肌力为3/5，肌张力和反射减弱。心电图显示窦性心律，心率88次/分钟。PR间期缩短，QT间期延长。血液检查显示血钾为1.8 mEq/L（正常范围3.5 - 5），游离T4为29.2 pmol/L（正常范围6.5 - 17），促甲状腺激素（TSH）<0.01 mIU/L（正常范围0.35 - 4.94）。随机尿钾为8.8 mEq/L（正常范围12.5 - 62.5）。患者最初被收入重症监护病房并给予静脉补钾。他的症状在24小时内缓解。他被诊断为甲状腺毒症性周期性麻痹。出院时给予他卡比马唑和普萘洛尔，并安排在内分泌科门诊随访。
