Tsai I-Hsun, Su Yu-Jang
Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
J Electrocardiol. 2019 May-Jun;54:93-95. doi: 10.1016/j.jelectrocard.2019.04.001. Epub 2019 Apr 4.
A 47-year-old man presented to our emergency department (ED) with limbs weakness for 2 h. His heart rate was 127 beats per minute and blood pressure was 95/49 mm Hg. He found weakness of limbs after 4-h sleep. Physical examinations revealed that the muscle strength of upper limbs is 3/5, and lower limbs are 2/5. Electrocardiogram (ECG) revealed wide QRS complex, monomorphic ventricular tachycardia (VT) with ST-segment depression and long QT interval. Serum potassium level was extremely low as 1.0 mEq/L. This led to periodic hypokalemic paralysis. Due to severe hypokalemia with possible atrioventricular block, the patient was admitted to the intensive care unit. During hospitalization, his potassium level returned to 5.1 mEq/L on the first day. He had a low level of thyroid stimulating hormone (TSH) of <0.03 micro-IU/mL (normal range: 0.25-4.00) and a high free thyroxine (T4) level of 2.43 ng/dL (normal range: 0.89-1.79 ng/dL). Therefore, hyperthyroidism was diagnosed, and 5 mg of methimazole was administered twice a day. The patient was discharged on the seventh day after admission. The final diagnosis is thyrotoxic periodic paralysis (TPP), also as known as nocturnal paralysis or night palsy.
一名47岁男性因四肢无力2小时就诊于我院急诊科。他的心率为每分钟127次，血压为95/49 mmHg。他在睡眠4小时后出现四肢无力。体格检查显示上肢肌力为3/5，下肢肌力为2/5。心电图显示宽QRS波群、单形性室性心动过速（VT）伴ST段压低和长QT间期。血清钾水平极低，为1.0 mEq/L。这导致了周期性低钾性麻痹。由于严重低钾血症并可能伴有房室传导阻滞，患者被收入重症监护病房。住院期间，他的血钾水平在第一天恢复到5.1 mEq/L。他的促甲状腺激素（TSH）水平低，<0.03微国际单位/毫升（正常范围：0.25 - 4.00），游离甲状腺素（T4）水平高，为2.43 ng/dL（正常范围：0.89 - 1.79 ng/dL）。因此，诊断为甲状腺功能亢进症，每天两次给予5毫克甲巯咪唑。患者在入院后第七天出院。最终诊断为甲状腺毒症性周期性麻痹（TPP），也称为夜间麻痹或夜瘫。
