RATIONALE:Thyrotoxic periodic paralysis is characterized by a sudden onset of hypokalemia and paralysis. This condition mainly affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle without typical symptoms such as palpitations, tremors, anxiety, and weight loss; this causes a difficulty in early diagnosis. Here, we reported a case of periodic paralysis in a patient with hyperthyroidism whose potassium level was within the normal range. PATIENT CONCERNS:A 33-year-old Taiwanese man presented to the emergency department with bilateral limb weakness (more severe in the lower limbs than in the upper limbs). On arrival, the patient's vital status was stable with clear consciousness. He denied experiencing recent trauma, back pain, chest pain, abdominal pain, headache or dizziness, or a fever episode. Physical examination showed no specific findings. Neurological examination showed weakness in the muscles of the bilateral upper and lower limbs. Muscle weakness was more severe in the proximal site than in the distal site. DIAGNOSIS:Blood examination showed normal complete blood count, normal renal and liver function, and normal potassium (3.5 mmol/L, normal range 3.5-5.1 mmol/L), sodium, and calcium levels; however, the examination showed impaired thyroid function (thyroid stimulating hormone: 0.04 uIU/mL, normal range 0.34-5.60 uIU/mL; free T4: 1.96 ng/dL, normal range 0.61-1.12 ng/dL). Brain computed tomography without contrast showed no obvious intra-cranial lesion. INTERVENTIONS:Intravenous potassium infusion (20 mEq/L) with normal saline was prescribed for the patient. OUTCOMES:After treatment, the patient felt a decrease in limb weakness. He was discharged from our emergency department with a scheduled follow-up in the endocrine outpatient department. LESSONS:TPP should be considered as a differential diagnosis in young Asian men presenting with limb paralysis that is more severe in the proximal site and in the lower limbs than in the distal site and in the upper limbs, respectively. It is important for emergency department physicians to consider TPP as a differential diagnosis as it can occur even if the patient's potassium level is within the normal range.

译文

理由:甲状腺毒性周期性麻痹的特点是突然出现低钾血症和麻痹。这种情况主要影响下肢,继发于甲状腺毒症。潜在的甲状腺功能亢进通常很细微,没有典型的症状,例如心pit,震颤,焦虑和体重减轻。这导致了早期诊断的困难。在这里,我们报道了一名甲状腺功能亢进症患者的周期性瘫痪,其钾水平在正常范围内。
患者注意事项:一名33岁的台湾男子因双侧肢体无力(下肢比上肢更严重)出现在急诊室。到达后,患者的生命状态稳定,意识清晰。他否认最近经历过外伤,背痛,胸痛,腹痛,头痛或头晕或发烧。体格检查未发现具体发现。神经系统检查显示双侧上肢和下肢的肌肉无力。与近端部位相比,近端部位的肌肉无力更为严重。
诊断:血液检查显示正常的全血细胞计数,正常的肾和肝功能以及正常的钾(3.5 mmol / L,正常范围3.5-5.1 mmol / L),钠和钙水平;然而,检查显示甲状腺功能受损(甲状腺刺激激素:0.04μuIU/ mL,正常范围0.34-5.60μuIU/ mL;游离T4:1.96μng/ dL,正常范围0.61-1.12μng/ dL)。没有对比的脑部计算机断层扫描显示没有明显的颅内病变。
干预措施:为患者开具静脉注射钾(20μmEq/ L)和生理盐水。
结果:治疗后,患者感到四肢无力减轻。他已从我们的急诊科出院,并计划在内分泌门诊部进行随访。
经验教训:TPP应该被视为亚洲年轻男性肢体麻痹的鉴别诊断,其近端部位和下肢部位比远端部位和上肢部位更为严重。对于急诊科医师而言,将TPP视为鉴别诊断非常重要,因为即使患者的钾水平在正常范围内,TPP也会发生。

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