Paz-Ibarra José Luis, Sáenz-Bustamante Sofia Mabel, Ildefonso-Najarro Sofía Pilar, Portillo-Flores Karina, Quispe-Flores María Alejandra, Plasencia-Dueñas Esteban Alberto, Concepción-Zavaleta Marcio José
Seguro Social de Salud del Perú, Hospital Nacional "Edgardo Rebagliati Martins", Servicio de Endocrinología. Lima, Perú.
Universidad Peruana Cayetano Heredia, Escuela del Pie Diabético. Lima, Perú.
Rev Med Inst Mex Seguro Soc. 2022 Jul 4;60(4):379-387.
Thyrotoxic Periodic Paralysis (PPT) is an uncommon complication of hyperthyroidism, it is the most frequent cause of acute flaccid paralysis in adults.
A retrospective observational study was carried out in 2 reference hospitals of the social security in Lima-Peru, which included 22 patients diagnosed with PPT during the period 2014-2021.
the average age at diagnosis was 35.77 ± 9.6 years, all of mixed race, in 82% of the patients the diagnosis of hyperthyroidism was established from this entity, the etiology in 95% was autoimmune (Graves-Basedow) except for one whose etiology was toxic multinodular goiter. The triggering event reported in 54% of patients was the intake of copious food high in carbohydrates, followed by exercise (27%), the most frequent presentation time was during the morning (41% of the cases), the main weakness pattern compromised lower limbs (45% paraplegia, 18% paraparesis), only 36% were diagnosed with PPT in their first episode of motor weakness.
We consider that this condition should be suspected in any young male patient of any ethnicity with acute muscle weakness, associated with low serum potassium levels and symptoms of thyrotoxicosis, although its absence should not rule out the diagnosis. The precipitating factor should be identified as much as possible and initial therapy with propanolol with or without intravenous or oral potassium replacement should be established, with adequate subsequent monitoring to minimize the risk of rebound hyperkalemia.
甲状腺毒症性周期性瘫痪(PPT)是甲状腺功能亢进症的一种罕见并发症,是成人急性弛缓性麻痹最常见的原因。
在秘鲁利马的2家社会保障参考医院进行了一项回顾性观察研究,纳入了2014年至2021年期间诊断为PPT的22例患者。
诊断时的平均年龄为35.77±9.6岁,均为混血人种,82%的患者甲状腺功能亢进症的诊断基于该疾病,95%的病因是自身免疫性(格雷夫斯-巴塞多氏病),只有1例的病因是毒性多结节性甲状腺肿。54%的患者报告的诱发事件是大量摄入高碳水化合物食物,其次是运动(27%),最常见的发病时间是早晨(41%的病例),主要的肌无力模式累及下肢(45%截瘫,18%轻瘫),只有36%在首次出现肌无力发作时被诊断为PPT。
我们认为,任何种族的年轻男性患者出现急性肌无力,伴有血清钾水平降低和甲状腺毒症症状时,都应怀疑患有这种疾病,尽管没有这些表现也不能排除诊断。应尽可能确定诱发因素,并建立使用普萘洛尔进行初始治疗,可联合或不联合静脉或口服补钾,随后进行充分监测以尽量降低反弹性高钾血症的风险。