Thyrotoxic periodic paralysis. A case report

Thyrotoxic hypokalemic periodic paralysis (TPP)--a rare complication of thyrotoxicosis and a medical emergency--is characterized by recurrent episodes of muscle weakness and hypokalemia associated with hyperthyroidism. We report a case of TPP in a 38-year-old white Lebanese male. The patient suffered from severe muscle weakness of the upper and lower limbs. His blood tests revealed hypokalemia (k: 2.4 mEq/L), low thyroid-stimulating hormone TSH (0.001 microIU/mL) and normal levels of thyroid hormones. The thyroid scan showed a hot nodule. His paralysis resolved with IV potassium. The patient was treated with propranolol and radioactive iodine with complete remission of the hyperthyroidism and the paralysis. A discussion of the clinical and pathophysiological features and treatment of TPP is presented.     

血睾酮水平与男性甲状腺功能亢进症伴周期性麻痹的关系

目的探讨毒性弥漫性甲状腺肿（Graves病）患者血睾酮水平与周期性麻痹的关系。方法选择男性甲状腺机能亢进症伴周期性麻痹（TPP组）患者组30例,单纯甲状腺机能亢进症（单纯甲亢组）患者组30例,比较两组组间血睾酮水平及相关实验室指标变化。结果TPP组体质量指数（bodymass index,BMI）、血睾酮高于单纯甲亢组（P〈0．05）,游离三碘甲状腺原氨酸（FL）、游离甲状腺素（n）低于单纯甲亢组（P〈0．05）。结论TTP患者存在高睾酮血症,血清钾下降可能与血清睾酮增高、血钾向细胞内转移有关。     

甲状腺功能亢进合并低钾血症及周期性麻痹的临床研究

回顾分析1225例甲状腺功能亢进症（甲亢）患者临床资料,了解低钾血症和周期性麻痹的发生情况.其中单纯低钾血症者104例（8.5%）,女性占82.7%（86/104）,血钾为3.10～3.42mmol/L;周期性麻痹者60例（4.9%）,男性占96.7%（58/60）,血钾低于3.0 mmol/L者占93.3%（56/60）.甲亢控制后低钾血症和周期性麻痹均可缓解.     

甲状腺毒性周期性麻痹患者反跳性高钾血症三例报道并文献复习

甲状腺毒性周期性麻痹（TPP）是由甲状腺毒症引起的一种内分泌急症,主要表现为周期性肌无力和低钾血症,严重威胁患者健康。血钾降低的水平与TPP患者肌无力的严重程度密切相关,补钾治疗能快速缓解患者的肌无力症状和低钾血症。但过量补钾治疗会导致TPP患者出现急性反跳性高钾血症,再次威胁患者的健康。本文报道了3例TPP患者因过量补钾治疗而导致急性反跳性高钾血症,分析引起反跳性高钾血症的危险因素,希望为TPP患者的临床治疗提供更多资料。     

甲亢性周期性瘫痪30例临床分析

目的探讨以低钾性瘫痪为主要临床表现的甲状腺功能亢进症(甲亢)的发病相关因素及治疗方法。方法对30例甲亢性周期性瘫痪(TPP)的临床资料进行回顾性分析。结果发作时均有不同程度双下肢或四肢瘫痪;T3、T4均高于正常。结论甲亢性周期性瘫痪以年轻男性多见,补钾短期内可改善TPP症状,抗甲亢治疗是预防TPP复发的关键。     

甲状腺功能亢进合并周期性麻痹18例临床分析

目的 探讨甲状腺功能亢进合并周期性麻痹的临床特点和有效地治疗方法。方法 回顾性分析了18例甲状腺功能亢进合并周期性麻痹患者的临床资料。结果 本组患者发病时均有不同程度的对称性下肢或四肢软瘫，17例伴有血钾降低，18例FT3，FT44均高于正常。结论 补钾治疗后可迅速改善症状，联合抗甲状腺治疗是防止甲状腺功能亢进合并周期性麻痹复发的重要措施。     

甲亢性周期性麻痹的遗传易感基因研究进展

甲亢性周期性麻痹(TPP)是甲亢的一种合并症,其发生存在着明显的性别和种族差异,由于遗传因素与环境因素相互作用而发病。本文简单介绍了TPP的临床特征和流行病学,报告了与其可能相关的易感基因。     

~(131)I治疗甲状腺功能亢进伴周期性麻痹(附42例分析)

甲状腺功能亢进(甲亢)伴周期性麻痹是一种临床常见病,口服药物治疗效果不佳.为探讨 131I对甲亢伴周期性麻痹的治疗价值,选择42例该类患者给予口服 131I 5.0～9.0 mCi(1 Ci=3.7×1010 Bq)治疗,评价周期性麻痹的缓解情况,结果表明, 131I治疗甲亢伴周期性麻痹疗效肯定,使用安全,不良反应轻微,值得临床推广应用.     

20例低血钾型周期性麻痹患者临床和病理分析

目的探讨低血钾型周期性麻痹（hypokalemie period paralysis,HOPP）患者的临床及骨骼肌病理特点。方法回顾性分析2005年9月—-2012年12月在河北医科大学第三医院做骨骼肌活检的HOPP患者20例,均行血钾、肌酸激酶、心电图及甲状腺功能检查。结果20例患者中,原发性HOPP组16例,甲状腺功能亢进合并HOPP组（TPP组）4例。TPP组的起病年龄较原发性HOPP组晚,（42．75±9．36）岁135（24．81±5．49）岁（P〈0．01）;原发性HOPP组与TPP组分别有43．75％（7／16）和25．00％（1／4）的患者存在血清肌酸激酶水平异常增高;2组患者血钾水平差异无统计学意义,（2．82士0．30）mmol／L125（2．58±0．13）mmol／L）;20例患者中,有8例（40．00％）骨骼肌活检见肌纤维胞浆中存在典型“管聚集”现象,其中原发性HOPP组7例,TPP组1例。结论低血钾型周期性麻痹“管聚集”的发病率为40．00％,8例患者存在肌纤维网结构紊乱、“管聚集”现象,原发性HOPP组“管聚集”现象较TPP组更常见;原发性HOPP组发病年龄较早。     

SCN4A基因Arg672His突变致低钾性周期性麻痹伴维生素D严重缺乏一例报道并文献复习

低钾性周期性麻痹（HypoPP）是一种常染色体显性遗传性离子通道疾病,以反复发作、骨骼肌松弛性瘫痪、低钾血症为主要特征。研究表明,约60%的HypoPP由CACNA1S基因R528H和RI239H突变导致,中国人群及东亚人群以CACNA1S基因突变多见,而SCN4A基因突变较为少见。本文报道了1例SCN4A基因Arg672His突变所致HypoPP伴维生素D严重缺乏患者,并进行了文献复习,提示维生素D缺乏可能导致腹泻并诱发HypoPP,临床发现低钾血症患者并明确排除其他病因后,需考虑到HypoPP的可能。     

甲状腺功能亢进并周期性麻痹的发病机制探讨

目的探讨甲状腺功能亢进(甲亢)并周期性麻痹的发病机制。方法15例男性甲亢并周期性麻痹的Graves病患者与15例男性甲亢非周期性麻痹的Graves病患者行临床对比分析，比较其一般情况，测定其FB、Fr4、s-TSH、空腹血糖(FBG)、餐后2h血糖(2h PBG)、空腹胰岛素(FINS)，计算胰岛素敏感指数(QUICKI)。结果甲亢并周期性麻痹组QUICKI指数明显低于甲亢非周期性麻痹组，空腹胰岛素水平明显高于甲亢非周期性麻痹组。结论胰岛素抵抗可能为甲亢患者发生周期性麻痹的原因之一。     

Hyperthyroidism with Periodic Paralysis

Hyperthyroidism may be associated with hypokalemic periodic paralysis. Two cases are presented demonstrating intermittent attacks of flaccid paralysis associated with clinical symptoms, signs and laboratory findings of hyperthyroidism. During an attack, one patient had a serum potassium of 2.1 mEq. per litre.

Various factors such as trauma, exposure to cold, excessive carbohydrate ingestion and certain medications have been stated to precipitate an episode of paralysis. Attacks may range from mild weakness to generalized flaccid paralysis with loss of deep tendon reflexes. Several reported patients have died owing to cardiac arrest or respiratory paralysis.

During attacks, the serum potassium is usually in the range of 2.2 to 3.2 mEq. per litre. It is postulated that a metabolic abnormality affecting the muscle-cell membrane can occur in the hyperthyroid state resulting in a shift of potassium to the intracellular position, thus producing a situation of hyperpolarization of the muscle-cell membrane which in turn alters the muscle contractibility.

The importance of recognizing the unusual association of hypokalemic periodic paralysis with hyperthyroidism is stressed because, with successful treatment of the hyperthyroidism, the episodes of paralysis disappear.

     

甲亢合并周期性麻痹26例临床诊治体会

目的探讨甲亢合并周期性麻痹的临床特点,减少漏诊、误诊的发生。方法回顾性分析26例甲亢合并周期性麻痹患者的临床资料。结果患者经补钾后1-18 h病情迅速缓解,并予正规抗甲状腺药物治疗后22例甲功恢复正常,2例反复发作2次,经调整抗甲状腺药物后甲功恢复正常,2例因口服药出现不良反应改^131I治疗甲功恢复正常。26例随访6个月-1年内无周期性麻痹复发。结论甲亢合并周期性麻痹补钾治疗后症状迅速改善,积极有效控制甲亢是预防复发的关键,同时注意避免饱餐、感染、过度劳累、静脉输入高渗葡萄糖等诱发因素。     

131I治疗甲亢合并周期性麻痹的疗效与护理

目的:观察131I治疗甲亢合并周期性麻痹的疗效及护理方法。方法:对28例患者在周期性麻痹缓解期进行治疗,采用一次口服给药法。结果:本组28例患者经131I治疗1个疗程治愈率为82.1%,2个疗程治愈率为92.9%,3个疗程治愈率为100%。结论:甲亢合并周期性麻痹用131I治疗治愈率高、疗程短、安全、方便,根据病人的生理特点及个体差异进行护理,也是治疗成功的关键。     

原发性甲状腺功能亢进症合并糖尿病的临床分析

目的探索原发性甲状腺功能亢进症合并糖尿病患者的临床特点及诊治。方法 126例甲亢合并糖尿病住院患者分为3组,即先诊断甲亢后合并糖尿病组、先诊断糖尿病后合并甲亢组和两种疾病同时诊断组,对其临床特点、诊治及疗效进行回顾性分析。结果甲亢与糖尿病同时诊断组症状更为典型,更容易合并心衰、心律失常、周期性麻痹等并发症;3组的甲状腺自身抗体阳性率差异无统计学意义(P>0.05);两病综合治疗中,胰岛素能有效控制空腹及餐后血糖,随着甲状腺激素逐渐恢复正常,胰岛素用量逐渐减少,合并症得到缓解。结论甲亢和糖尿病均为自身免疫性内分泌系统疾病,应相互筛查两者指标,尽早明确诊断并及时治疗。     

Periodic paralysis complicating malaria.

Episodic muscular weakness, commonly associated with alterations of serum potassium, is the cardinal feature of periodic paralysis. The combination of transient hyperkalaemia and rigors occurring during febrile episodes of malaria is suggested as the underlying cause which precipitated the muscular paralysis. Three patients with malaria who developed a similar paralysis during the paroxysms of fever are described to illustrate this.     

低钾型周期性麻痹43例临床分析

目的:观察低钾型周期性麻痹的临床特点并探讨其治疗方法。方法:分析43例病人的临床表现及辅助检查结果。结果:本组病人均四肢瘫痪,腱反射呈多样性,肌张力低,无1例有病理征。结论:根据低钾型周期性麻痹的临床特点,不难对其做出正确的诊断和恰当的处理,对腱反射的观察有待进一步探讨。     

Graves' disease: immunological and immunogenetic indicators of relapse

The use of measurements of antibody to the thyroid stimulating hormone receptor and HLA-DR3 phenotype for predicting relapse of hyperthyroidism in patients with Graves' disease receiving medical treatment is controversial. Fifty eight new patients with Graves' disease were followed up prospectively for up to 96 months after treatment with antithyroid drugs for 12 months. The presence of antibody to the thyroid stimulating hormone receptor before the start of treatment, measured as immunoglobulins inhibiting binding of thyroid stimulating hormone, was not associated with relapse. Patients who remained positive for antibodies after treatment tended to relapse within six months, but no relation with long term relapse was found. HLA-Cw7 but not HLA-DR3 was significantly associated with relapse. The presence of HLA-DR4 was significantly associated with remission and with absence of antibodies to thyroid stimulating hormone receptor. HLA-DR4 may therefore protect against relapse of thyrotoxicosis by immunomodulation triggered by antithyroid drugs, which results in the synthesis of antibodies to the thyroid stimulating hormone receptor being inhibited.     

甲状腺机能亢进症合并周期性麻痹

甲状腺机能亢进症可伴发周期性麻痹。本文报告14例,占甲亢病人的5％。其中13例为低钾型周期性麻痹,1例为正钾型。本文简要评述甲亢并周期性麻痹的发病机理、临床特征及治疗。认为周期性麻痹发作与低钾血症、胰岛索分泌过多、肾上腺素能兴奋性增高及血浆醛同酮水平提高等因素有关。     

Graves甲亢应用131碘治疗前后血糖水平变化观察

目的观察Graves甲亢在131碘治疗前后血糖水平变化及其临床意义.方法Graves甲亢患者在服131碘治疗前后分别测定甲状腺激素、空腹血糖、餐后2小时血糖的水平,并设健康对照组.结果Graves甲亢患者治疗前空腹血糖、餐后2小时血糖均高于健康对照组,组间有显著性差异(P＜0.05).而治疗后空腹血糖、餐后2小时血糖指标异常均有明显改善,与健康对照组无显著性差异(P＞0.05).结论Graves甲亢患者临床治疗上应以纠正甲状腺功能异常为主,并监测血糖变化,及时防治并发症.