Iskander Beshoy, Malik Bilal Haider, Cancarevic Ivan
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2020 May 17;12(5):e8169. doi: 10.7759/cureus.8169.
Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism. The pathophysiology of hyperthyroidism causing periodic paralysis involves the Na+/K+ ATPase and potassium channels. We present a case of a 30-year-old male who presented to the ED with acute onset of upper and lower limb weakness. The patient was found to have bilateral weakness in the upper and lower limbs, orbital hypertelorism, and mandibular hypoplasia. He was also found to have hypokalemia, low thyroid-stimulating hormone (TSH), elevated thyroid peroxidase antibody, and elevated thyroid-stimulating immunoglobulins. The patient's EKG was remarkable for a prolonged QTc interval. The patient regained his muscle strength after potassium replacement in less than 24 hours. He was started on methimazole and potassium supplements. Our case is unique because it shows the possibility of the presence of Andersen-Tawil syndrome (ATS) (long QT syndrome 7), diagnosed by the presence of periodic paralysis, long QT, and dysmorphic facial features with TPP. In conclusion, thyrotoxicosis can trigger ATS; also the two syndromes can co-exist owing to the similarity in their pathophysiology.
甲状腺毒症性周期性瘫痪（TPP）是甲状腺功能亢进症的一种罕见表现。甲状腺功能亢进症导致周期性瘫痪的病理生理学涉及钠钾ATP酶和钾通道。我们报告一例30岁男性，因急性上下肢无力就诊于急诊科。该患者被发现上下肢双侧无力、眼距增宽和下颌发育不全。还发现他有低钾血症、促甲状腺激素（TSH）降低、甲状腺过氧化物酶抗体升高和促甲状腺素受体抗体升高。患者的心电图显示QTc间期延长。患者在补钾后不到24小时恢复了肌肉力量。开始给予他甲巯咪唑和补钾治疗。我们的病例很独特，因为它显示了存在安德森-陶威尔综合征（ATS）（长QT综合征7型）的可能性，通过周期性瘫痪、长QT以及TPP伴面部畸形特征来诊断。总之，甲状腺毒症可引发ATS；而且由于这两种综合征病理生理学相似，它们可能共存。
