Garla Vishnu Vardhan, Gunturu Manasa, Kovvuru Karthik Reddy, Salim Sohail Abdul
MD., Assistant Professor, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, USA.
MD., Resident Physician, Department of Neurology, University of Mississippi Medical Center, Jackson, USA.
Electron Physician. 2018 Aug 25;10(8):7174-7179. doi: 10.19082/7174. eCollection 2018 Aug.
Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism. It is characterized by sudden onset paralysis associated with hypokalemia. Management includes prompt normalization of potassium, which results in resolution of the paralysis. Definitive treatment of hyperthyroidism resolves TPP completely.
A 23-year-old African American male patient presented to the emergency room at the University of Mississippi Medical Center, USA in November 2016 with sudden onset quadriplegia. He also endorsed a history of weight loss, palpitations, heat intolerance and tremors. The patient reported similar episodes of quadriplegia in the past, which were associated with hypokalemia and resolved with normalization of potassium levels. Physical examination was significant for exophthalmos, smooth goiter with bruit consistent with the diagnosis of Graves' disease. Laboratory assessment showed severe hypokalemia, hypomagnesemia, suppressed thyroid stimulating hormone (TSH) and high free thyroxine (T4). Urine potassium creatinine ratio was less than one, indicating transcellular shift as the cause of hypokalemia. After normalization of potassium and magnesium, the paralysis resolved in 12 hours. He was started on methimazole. On follow up, the patient was clinically and biochemically euthyroid with no further episodes of paralysis.
TAKE-AWAY LESSON: TPP is a rare and reversible cause of paralysis. Physicians need to be aware of the diagnostic and treatment modalities as delayed recognition in treatment could result in potential harm or unnecessary interventions.
甲状腺毒症性周期性瘫痪（TPP）是甲状腺功能亢进症一种罕见且可能致命的并发症。其特征为与低钾血症相关的突发瘫痪。治疗包括迅速使血钾正常化，这会使瘫痪症状缓解。甲状腺功能亢进症的确定性治疗可使TPP完全缓解。
一名23岁的非裔美国男性患者于2016年11月就诊于美国密西西比大学医学中心急诊室，出现突发四肢瘫痪。他还自述有体重减轻、心悸、不耐热及震颤病史。患者报告过去有类似的四肢瘫痪发作，与低钾血症相关，血钾水平正常后症状缓解。体格检查发现显著突眼、有血管杂音的光滑甲状腺肿，符合格雷夫斯病的诊断。实验室评估显示严重低钾血症、低镁血症、促甲状腺激素（TSH）受抑制及游离甲状腺素（T4）升高。尿钾肌酐比值小于1，提示细胞内转移是低钾血症的原因。血钾和血镁正常化后，瘫痪在12小时内缓解。他开始服用甲巯咪唑。随访时，患者临床及生化指标均处于甲状腺功能正常状态，未再出现瘫痪发作。
TPP是一种罕见且可逆转的瘫痪病因。医生需要了解其诊断和治疗方法，因为治疗中延迟识别可能导致潜在伤害或不必要的干预。
