Singh Jitendra, Dinkar Anju, Kumar Nilesh, Kumar Kailash
Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Am J Med Sci. 2023 May;365(5):462-469. doi: 10.1016/j.amjms.2023.01.009. Epub 2023 Feb 6.
Hypothyroidism, a commonly encountered thyroid disorder, usually manifests with readily recognizable typical features. However, an unusual presentation of a classic thyroid disorder may hinder accurate diagnosis in certain instances. One such rare initial presentation of hypothyroidism is recurrent hypokalemic paralysis, and existing reports in the literature are sparse. It has been more commonly reported in thyrotoxicosis. We report the case details and clinical outcomes of two middle-aged individuals (a 34-year-old male and a 37-year-old female) with recurrent episodes of hypokalemic paralysis. Their clinical examination revealed pure motor hyporeflexia quadriparesis with hypotonia and diminished deep tendon reflexes without any autonomic dysfunction. They had no significant previous medical history. Biochemical findings revealed hypokalemia in both cases (1.4 and 1.9 mEq/L, respectively) with elevated levels of thyroid‑stimulating hormone and thyroid‑related antibodies in both individuals, thus, confirming the diagnosis of autoimmune hypothyroidism. Immediate treatment with intravenous and oral potassium correction helped in the recovery. Thyroxine supplementation was considered a follow-up treatment, and for a one-year follow-up period there were no complaints of limb weakness reported in both individual.
甲状腺功能减退症是一种常见的甲状腺疾病，通常表现为易于识别的典型特征。然而，在某些情况下，经典甲状腺疾病的不寻常表现可能会妨碍准确诊断。甲状腺功能减退症一种罕见的初始表现是反复发作的低钾性麻痹，而文献中的现有报道很少。它在甲状腺毒症中报道更为常见。我们报告了两名中年患者（一名34岁男性和一名37岁女性）反复发作低钾性麻痹的病例细节和临床结果。他们的临床检查显示为单纯运动性低反射性四肢瘫，伴有肌张力减退和深部腱反射减弱，无任何自主神经功能障碍。他们既往无重大病史。生化检查结果显示，两例均有低钾血症（分别为1.4和1.9 mEq/L），两人甲状腺刺激素和甲状腺相关抗体水平均升高，从而确诊为自身免疫性甲状腺功能减退症。立即进行静脉和口服补钾治疗有助于恢复。补充甲状腺素被视为后续治疗，在为期一年的随访期内，两人均未报告肢体无力的主诉。
