背景:甲状腺毒性周期性麻痹(TPP)是一种罕见且最常见的获得性低钾性周期性麻痹亚型。不同程度的肌肉无力的关联,甲状腺功能亢进和低钾血症是其特征。治疗需要补充钾,甲亢的控制及预防措施。这是亚洲男性的常见疾病,但在高加索或非洲人群中很少见。这是非洲男性与乳酸代谢性酸中毒相关的TPP的第一份报告。
方法:一名23岁的非洲男子,原产于摩洛哥,连续11个月反复发作的四瘫,还有腹痛,已提交评估。生化检查显示,严重的低钾血症与甲状腺功能亢进和乳酸代谢性酸中毒有关。他的心电图显示低钾血症的迹象,例如窦性心动过速和U波。补钾后,神经系统恢复迅速和完全。甲状腺超声发现低回声和高血管化甲状腺肿,与高水平的甲状腺抗体相关,赞成格雷夫病。随着抗甲状腺药物和生活方式的改变,病人没有任何其他的攻击。
方法:除了病例报告外,本文对文献进行了扩展回顾,从1957年第一个报告TPP诊断和发病率的大型研究到现在。这里报道了有关流行病学的最新信息,临床表现,补充考试,管理和遗传发现。最初观察到的乳酸性酸中毒异常,在TPP中从未描述过。TPP是诊断和治疗紧急情况,需要仔细补充钾,为了避免反弹高钾血症发作的风险,维持,直到病因治疗有效。急诊心电图和肌电图的临床评估对于评估影响至关重要。
结论:面对任何低钾血症性周期性麻痹,包括非亚洲科目,搜索甲状腺功能亢进.
结论:本报告证明了甲状腺检查在急性肌无力的情况下的重要性,即使在非亚洲患者中也是如此,以诊断TPP。这是一种罕见但可能的病因,与家族性形式的低钾性周期性瘫痪相区别。它还质疑TPP对能量代谢的影响,特别是在乳酸代谢方面。
BACKGROUND: Thyrotoxic periodic paralysis (TPP) is a rare and most often acquired subtype of hypokalemic periodic paralysis. The association of varying degrees of muscle weakness, hyperthyroidism and hypokalemia characterizes it. The treatment requires potassium supplementation, control of hyperthyroidism and prevention measures. It is a frequent disease in Asian men, but much rare in Caucasian or African populations. This is the first report of TPP associated with lactic metabolic acidosis in an African man.
METHODS: A 23 year-old African man, native from Morocco, with recurrent episodes of tetraparesis for eleven months, and abdominal pain, was referred for evaluation. Biochemical investigations showed severe hypokalemia associated with hyperthyroidism and lactic metabolic acidosis. His EKG showed signs of hypokalemia such as sinus tachycardia and U waves. After potassium supplementation, neurological recuperation was quick and complete. Thyroid ultrasound identified a hypoechogenic and hypervascularized goiter, associated with high levels of thyroid antibodies, in favor of Grave\'s disease. With antithyroid drugs and life-style changes, the patient did not have any other attack.
METHODS: In addition to the case report, this article presents an extended review of literature, from the first large study reporting the diagnosis and incidence of TPP in 1957 to nowadays. Are reported here the latest information concerning epidemiology, clinical manifestations, complementary examinations, management and genetic finding. The lactic acidosis observed initially is exceptional, never described in TPP. TPP is a diagnostic and therapeutic emergency, requiring careful potassium supplementation, in order to avoid the risk of the onset of rebound hyperkalemia, to be maintained until the etiological treatment is effective. Paraclinical assessment with emergency EKG and electromyogram are essential to assess the impact.
CONCLUSIONS: It is essential in the face of any hypokalaemic periodic paralysis, including in non-Asian subjects, to search hyperthyroidism.
CONCLUSIONS: This report demonstrates the importance of thyroid testing in case of acute muscle weakness, even in non-Asian patients in order to diagnose TPP. This is a rare but possible etiology, to be distinguished from the familial form of hypokalemic periodic paralysis. It also questions on the impact of TPP on energetic metabolism, in particular on lactic metabolism.