Hipokalemijska tireotoksična periodična paraliza kod mladog muškarca u Srbiji

  • Petar Military Medical Academy, Endocrinology Clinic, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Tamara Dragović Endocrinology Clinic, Military Medical Academy Belgrade, Serbia
  • Saša Kiković Endocrinology Clinic, Military Medical Academy Belgrade, Serbia
  • Dragana Ristić Military Medical Academy, Ophtalmology Clinic, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Marija Zdravković University Hospital Medical Center “Bežanijska Kosa”, Department of Cardiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Saša Hinić University Hospital Medical Center “Bežanijska Kosa”, Department of Cardiology, Belgrade, Serbia
  • Tijana Durmić University of Belgrade, Faculty of Medicine, Institute of Forensic Medicine “Milovan Milovanović”, Belgrade, Serbia
  • Zoran Hajduković Military Medical Academy, Endocrinology Clinic, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP161130064R
Ključne reči: hipertireoidizam;, hipokaliemija;, paraliza;, lečenje lekovima;, lečenje, ishod

Sažetak


Uvod. Hipokalemijska tireotoksična paraliza je veoma retka forma periodične paralize u beloj populaciji. U ovoj po­pulaciji je zastupljenija familijarna hipokalemijska periodična paraliza sa istom kliničkom slikom. To je flacidna paraliza proksimalne muskulature ekstremiteta. Imajući u vidu či­nje­nicu da je kod ovih bolesnika klinička slika hipertireoidizma blaža nego što bi se očekivalo, kada su u pitanju vrednosti hormona štitaste žlezde, veoma je važna diferencijalna dijagnoza u odnosu na ostale forme hipokalemijskih para­liza. Prikaz bolesnika. U radu je prikazan mlađi muškarac sa hipertireoidizmom i teškim oblikom flacidne paralize najizraženije u mišićima donjih ekstre­miteta. Laboratorijska analiza ukazala je na povišene vrednosti hormona štitaste žlezde i na hipokalemiju tokom napada, uz normalizaciju vrednosti kalijuma u periodima remisije. Porodična anam­ne­za je bila negativna na slična stanja, a bo­lesnik u prethod­nom periodu nije imao ovakve napade. Nakon isključenja drugih potencijalnih uzroka ovog pore­mećaja, zapo­četo je sa intenzivnom terapijom hipertireoidizma, a napadi hipokale­mijske periodične paralize su kupirani primenom infuzije ka­lijum hlorida (KCl). Bolesniku je savetovano da nakon sta­bilizacije nivoa hormona štitaste žlezde započne sa definitiv­nom terapijom hipertireoidizma. Zaključak. Hipokale­mij­ska tireotoksična paraliza je retko i potencijalno opasno sta­nje koje, ukoliko se na vreme prepozna, može biti kupirano terapijom hipertireoze i upotrebom neselektivnih β blokatora.

Reference

Vijayakumar A, Ashwath G, Thimmappa D. Thyrotoxic periodic paralysis: clinical challenges. J Thyroid Res 2014; 2014: 649502.

Akar S, Comlekci A, Birlik M, Onen F, Sari I, Gurler O, et al. Thyrotoxic periodic paralysis in a turkish male; the recurrence of the attack after radioiodine treatment. Endocr J 2005; 52(1): 149–51.

Tinker TD, Vannatta JB. Thyrotoxic hypokalemic periodic paralysis: report of four cases and review of the literature (2). J Okla State Med Assoc 1987; 80(2): 76–83.

Hsu FS, Tsai WS, Chau T, Chen HH, Chen YC, Lin SH. Thyrotropin-secreting pituitary adenoma presenting as hypokalemic periodic paralysis. Am J Med Sci 2003; 325(1): 48–50.

Norris FH Jr, Clark EC, Biglieri EG. Studies in thyrotoxic periodic paralysis. J Neurol Sci 1971; 13(4): 431–42.

Kelley DE, Gharib H, Kennedy FP, Duda RJ Jr, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Intern Med 1989; 149(11): 2597–600.

Okihiro MM, Nordyke RA. Hypokalemic periodic paralysis. Experimental precipitation with sodium liothyronine. JAMA 1966; 198(8): 949–51.

Tran HA. Inadvertent iodine excess causing thyrotoxic hypokalemic periodic paralysis. Arch Intern Med 2005; 165(21): 2536; author reply 2536.

Ahlawat SK, Sachdev A. Hypokalaemic paralysis. Postgrad Med J 1999; 75(882): 193–7.

Rosenfeld M. Acute aufsteigende lahmung bei morbus Basedow. Klin Wochenschr (Berl) 1902 39: 538–40.

Okinaka S, Shizume K, Uno S, Watanabe A, Irie M, Noguchi A, et al. The Association of Periodic Paralysis and Hyperthyroidism in Japan. J Clin Endocrinol Metab 1957; 17(12): 1454–9.

Kelley DE, Gharib H, Kennedy FP, Duda RJ, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Int Med 1989; 149(11): 2597–600.

Dixon AN, Jones R. Thyrotoxic periodic paralysis in a white woman. Postgrad Med J 2002; 78(925): 687–8.

Chang CC, Cheng CJ, Sung CC, Chiueh TS, Lee CH, Chau T, et al. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants. Eur J Endocrinol 2013; 169(5): 529–36.

McFadzean AJ, Yeung R. Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1967; 1(5538): 451–5.

Ko GT, Chow CC, Yeung VT, Chan HH, Li JK, Cockram CS. Thyrotoxic periodic paralysis in a Chinese population. QJM 1996; 89(6): 463–8.

Levitt JO. Practical aspects in the management of hypokalemic periodic paralysis. J Transl Med 2008; 6: 18.

Manoukian MA, Foote JA, Crapo LM. Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med 1999; 159(6): 601–6.

Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis 2001; 37(3): 620–3.

Ober KP. Thyrotoxic Periodic Paralysis in the United States Report of 7 Cases and Review of the Literature. Medicine (Baltimore) 1992; 71(3): 109–20.

Soonthornpun S, Setasuban W, Thamprasit A. Insulin resistance in subjects with a history of thyrotoxic periodic paralysis (TPP). Clin Endocrinol (Oxf) 2009; 70(5): 794–7.

Chan A, Shinde R, Chow CC, Cockram CS, Swaminathan R. Hyperinsulinaemia and Na+, K+-ATPase activity in thyro-toxic periodic paralysis. Clin Endocrinol (Oxf) 1994; 41(2): 213–6.

Dias Da Silva MR, Cerutti JM, Arnaldi LA, Maciel RM. A mutation in the KCNE3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic para-lysis. J Clin Endocrinol Metab 2002; 87(11): 4881–4.

Ptácek LJ, Tawil R, Griggs RC, Engel AG, Layzer RB, Kwieciński H, et al. Dihydropyridine receptor mutations cause hypo¬ka¬le-mic periodic paralysis. Cell 1994; 77(6): 863–8.

Chan A, Shinde R, Chow CC, Cockram CS, Swaminathan R. In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis. BMJ 1991; 303(6810): 1096–9.

Puwanant A, Ruff RL. INa and IKir are reduced in Type 1 hypokalemic and thyrotoxic periodic paralysis. Muscle Nerve 2010; 42(3): 315–27.

Ruff RL. Insulin acts in hypokalemic periodic paralysis by reducing inward rectifier K current. Neurology 1999; 53(7): 1556–63.

Ryan DP, da Silva MR, Soong TW, Fontaine B, Donaldson MR, Kung AW, et al. Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis. Cell 2010; 140(1): 88–98.

Tricarico D, Servidei S, Tonali P, Jurkat-Rott K, Camerino DC. Impairment of skeletal muscle adenosine triphosphate-sensi-tive K+ channels in patients with hypokalemic periodic paralysis. J Clin Invest 1999; 103(5): 675–82.

Fontaine B, Lapie P, Plassart E, Tabti N, Nicole S, Reboul J, et al. Periodic paralysis and voltage-gated ion channels. Kidney Int 1996; 49(1): 9–18.

Objavljeno
2021/05/21
Broj časopisa
Vol. 77 Br. 4 (2020): Vojnosanit Pregl
Rubrika
Prikaz bolesnika