週期性麻痺併甲狀腺毒症-病例報告

Periodic Paralysis with Thyrotoxicosis Case Report and Review of Literature

曾國楨(Kuo-Chen Tseng) ； 高宗妙(Chung-Miu Kaw) ； 陳奕錫(Yi-Shin Chen)

《中華民國復健醫學會雜誌》 23卷1期 (1995/06) Pp. 77-83

摘要

Periodic paralysis is a repetitive, transient muscle weakness syndrome. It lasts from minutes to several hours even for days. It often involves proximal and trunk muscle groups, but rare in ocular, bulbar muscles. There is a striking predilection for young males. EMG studies reveal relationships between periodic paralysis and muscle membrane deplarization, and there is compound muscle action potential decrease after vigorous exercise. Potassium imbalance between intracelluar space and serum is the probable reason for this phenomenon. About 2-30% periodic paralysis has connections with thyrotoxicosis. Hyperthyroidism victim is more easiler to affect periodic paralysis than normal one. As some symptoms of periodic paralysis are pre-
ventable and curable, it deserves further investigation about the mechanism, course and treatment of periodic paralysis.
This paper reports a 34-year-old young male victim suffering from recurrent transient attacks of muscle weakness in the last 3 months before admission. Each episode lasted from few hours to half a day. About 10 episods were noted during recent 3 months. The severity of symptoms varied from mild weakness to complete paralysis. The last attack with complete paralysis of both legs occurred 3 days before the OPD visit, but patient recovered before admission. Under the impression of spinal cord or other CNS lesion, some exams were done at other hosptial, including MRI and EMG. Both were normal. No definite conclusion was made then. After admission, hyperthyroidism (T3: 3.45 ng/ml, T4 15.4 ug/dl, TSH ＜ 0.05 ulU/ml), hand tremors, increased perspiration, body weight loss restlessness and heart systolic murmurs were found. Serum potassium concentration was normal. Thyroid. echo revealed Grave's disease. Carioecho showed HCVD with septal hypertrophy. Thyrotoxicosis with periodic paralysis was diagnosed. After intensive care, hyperthroidism was corrected and oral potassium agent was supplemented, the patient was discharged and followed up at OPD.
Our conclusion is summarized as follows: Grave's disease is the most common cause of hyperthyroidism in thyrotoxicosis peroidic paralysis. Thyroid function test should be routinely monitered in patients with hypokalemic periodic paralysis. The. pathophysiology of thyrotoxicosis with peroidic paralysis is still not well understood. The paralysis may recur with the recurrence of the hyperthyroidism. Further investigation for this dramatic muscle paralysis disease is essential.

關鍵字

週期性麻痺 ； 甲狀腺毒症

並列摘要

Periodic paralysis is a repetitive, transient muscle weakness syndrome. It lasts from minutes to several hours even for days. It often involves proximal and trunk muscle groups, but rare in ocular, bulbar muscles. There is a striking predilection for young males. EMG studies reveal relationships between periodic paralysis and muscle membrane deplarization, and there is compound muscle action potential decrease after vigorous exercise. Potassium imbalance between intracelluar space and serum is the probable reason for this phenomenon. About 2-30% periodic paralysis has connections with thyrotoxicosis. Hyperthyroidism victim is more easiler to affect periodic paralysis than normal one. As some symptoms of periodic paralysis are pre-
ventable and curable, it deserves further investigation about the mechanism, course and treatment of periodic paralysis.
This paper reports a 34-year-old young male victim suffering from recurrent transient attacks of muscle weakness in the last 3 months before admission. Each episode lasted from few hours to half a day. About 10 episods were noted during recent 3 months. The severity of symptoms varied from mild weakness to complete paralysis. The last attack with complete paralysis of both legs occurred 3 days before the OPD visit, but patient recovered before admission. Under the impression of spinal cord or other CNS lesion, some exams were done at other hosptial, including MRI and EMG. Both were normal. No definite conclusion was made then. After admission, hyperthyroidism (T3: 3.45 ng/ml, T4 15.4 ug/dl, TSH ＜ 0.05 ulU/ml), hand tremors, increased perspiration, body weight loss restlessness and heart systolic murmurs were found. Serum potassium concentration was normal. Thyroid. echo revealed Grave's disease. Carioecho showed HCVD with septal hypertrophy. Thyrotoxicosis with periodic paralysis was diagnosed. After intensive care, hyperthroidism was corrected and oral potassium agent was supplemented, the patient was discharged and followed up at OPD.
Our conclusion is summarized as follows: Grave's disease is the most common cause of hyperthyroidism in thyrotoxicosis peroidic paralysis. Thyroid function test should be routinely monitered in patients with hypokalemic periodic paralysis. The. pathophysiology of thyrotoxicosis with peroidic paralysis is still not well understood. The paralysis may recur with the recurrence of the hyperthyroidism. Further investigation for this dramatic muscle paralysis disease is essential.

並列關鍵字

periodic paralysis ； thyrotoxicosls