Tsai Ming-Hsien, Lin Shih-Hua, Leu Jyh-Gang, Fang Yu-Wei
From the Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital (MHT, JGL, YWF); and Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (SHL).
Medicine (Baltimore). 2015 Sep;94(39):e1689. doi: 10.1097/MD.0000000000001689.
Thyrotoxic periodic paralysis (TPP) is characterized by the presence of muscle paralysis, hypokalemia, and hyperthyroidism. We report the case of a young man with paralysis of the lower extremities, severe hypokalemia, and concurrent hyperthyroidism. TPP was suspected; therefore, treatment consisting of judicious potassium (K+) repletion and β-blocker administration was initiated. However, urinary K+ excretion rate, as well as refractoriness to treatment, was inconsistent with TPP. Chronic alcoholism was considered as an alternative cause of hypokalemia, and serum K+ was restored through vigorous K repletion and the addition of K+ -sparing diuretics. The presence of thyrotoxicosis and hypokalemia does not always indicate a diagnosis of TPP. Exclusion of TPP can be accomplished by immediate evaluation of urinary K+ excretion, acid-base status, and the amount of potassium chloride required to correct hypokalemia at presentation.
甲状腺毒症性周期性瘫痪（TPP）的特征是存在肌肉麻痹、低钾血症和甲状腺功能亢进。我们报告了一例年轻男性病例，该患者出现下肢麻痹、严重低钾血症并伴有甲状腺功能亢进。怀疑为TPP；因此，开始了包括谨慎补钾和使用β受体阻滞剂的治疗。然而，尿钾排泄率以及对治疗的难治性与TPP不一致。慢性酒精中毒被认为是低钾血症的另一个原因，通过积极补钾和加用保钾利尿剂使血清钾恢复正常。甲状腺毒症和低钾血症的存在并不总是意味着诊断为TPP。通过立即评估尿钾排泄、酸碱状态以及纠正就诊时低钾血症所需的氯化钾量，可以排除TPP。
