甲狀腺毒性週期性麻痺－三病例報告

Thyrotoxic Periodic Paralysis: Report of Three Cases

吳中恒(Jong-Herng Wu) ； 莊光輝(Guang-Huei Juang)

《慈濟醫學雜誌》 7卷4期 (1995/12) Pp. 307-313

https://doi.org/10.6440/TZUCMJ.199512.0307

摘要

甲狀腺毒性週期性麻痺是一相當少見的症候群，病人常因下肢漸進性肌肉無力，無法站立，而來急診室求診，但往往由於急診醫師認知不夠而有錯誤的診斷。本文病例報告有3例，全為男性，年齡21-29歲，入院主訴皆以漸進性下肢肌肉無力為主，過去皆有相同情況，另外病例1.合併上肢肌肉無力及急性呼吸衰竭。治療方法，以內科成外科方法使甲狀腺功能恢復正常為主；對於低血鉀症治療，除以鉀離子補充外，並需定時監測血鉀濃度，防止高血鉀症副作用。以Propranolol預防低血鉀症，效果不錯。在此，我們著重在討論此症後的鑑別診斷，病理機轉，床表徵及處置。

關鍵字

甲狀腺毒症 ； 週基性痲痺,低血鉀症

並列摘要

Thyrotoxic periodic paralysis is a relatively uncommon syndrome. Its characteristics may be unfamiliar to many emergency physicians, and it may be misdiagnosed due to physicians’ ignorance. The three cases reported here are all males, aged 21-29 years old. All of them had the chief complaint of rapidly progressive muscular weakness, which predominantly affected the lower extremities. The same symptom had occurred previously. In addition, case 1 had muscular weakness of the upper extremities and respiratory failure. Definitive treatment of thyrotoxic periodic paralysis should be directed to establish a euthyroid state, either medically or surgically. Potassium is frequently administered to hasten recovery. Serum potassium, however, must be carefully monitored during treatment to avoid the adverse effect of hyperkalemia. Beta-blocking agents are effective for the prevention of hypokalemia. Here, we focus our attention on the discussion of the differential diagnosis, pathogenesis, clinical manifestation, and mangement of this interesting syndrome.

並列關鍵字

thyrotoxicosis,periodic paralysis,hypokalemia