Thyrotoxic periodic paralysis as initial manifestation of Graves' disease in a 16-year-old Korean adolescent
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Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, with recurrent muscle paralysis and hypokalemia that are caused by an intracellular shift of potassium. TPP is relatively common in Asian males, but is extremely rare in children and adolescents, even for those of Asian descent. We describe a 16-year-old Korean adolescent presenting with a two-week history of episodic leg weakness in the morning. He showed sinus tachycardia, lower leg weakness, and hypokalemia. Thyroid function test showed hyperthyroidism, and thyroid ultrasonography revealed a diffuse enlarged thyroid with increased vascularity, consistent with Graves’ disease. He was treated with β-adrenergic blocker and antithyroid drugs. He has been symptom free for one year, as his hyperthyroidism has been controlled well with antithyroid drugs. TPP should be considered in children and adolescents with acute paralysis of the lower extremities and hypokalemia.
Abstract
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, with recurrent muscle paralysis and hypokalemia that are caused by an intracellular shift of potassium. TPP is relatively common in Asian males, but is extremely rare in children and adolescents, even for those of Asian descent. We describe a 16-year-old Korean adolescent presenting with a two-week history of episodic leg weakness in the morning. He showed sinus tachycardia, lower leg weakness, and hypokalemia. Thyroid function test showed hyperthyroidism, and thyroid ultrasonography revealed a diffuse enlarged thyroid with increased vascularity, consistent with Graves’ disease. He was treated with β-adrenergic blocker and antithyroid drugs. He has been symptom free for one year, as his hyperthyroidism has been controlled well with antithyroid drugs. TPP should be considered in children and adolescents with acute paralysis of the lower extremities and hypokalemia.
참고문헌 (20)
- Ober KP, "Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature", Medicine, 71, pp.109~120 (1992)
- McFadzean AJ, "Periodic paralysis complicating thyrotoxicosis in Chinese", Br Med J, 1, pp.451~455 (1967)
- Kelley DE, "Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings", Arch Intern Med, 149, pp.2597~2600 (1989)
- Lee JI, "Thyrotoxic periodic paralysis presenting as polymorphic ventricular tachycardia induced by painless thyroiditis", Thyroid, 19, pp.1433~1434 (2009)
- Miller JD, "Nonfamilial hypokalemic periodic paralysis and thyrotoxicosis in a 16-year-old male", Pediatrics, 100(3 Pt 1), pp.412~ (1997)
- Wong GW, "Thyrotoxic periodic paralysis in a 14-year-old boy", Eur J Pediatr, 159, pp.934~ (2000)
- 오기원, "갑상샘중독 주기성 마비를 보인 그레이브스병 청소년 1예", Annals of Pediatirc Endocrinology & Metabolism, 16(3), pp.196~200 (2011), 대한소아내분비학회
- 안문배, "16세 청소년에서 발생한 갑상샘중독 주기성 마비 1례", Annals of Pediatirc Endocrinology & Metabolism, 17(2), pp.117~121 (2012), 대한소아내분비학회[DOI]
- Azuma KK, "Thyroid hormone specifically regulates skeletal muscle Na(+)-K(+)-ATPase alpha 2- and beta 2-isoforms", Am J Physiol, 265(3 Pt 1), pp.C680~C687 (1993)
- Chan A, "In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis", BMJ, 303, pp.1096~1099 (1991)
- Kjeldsen K, "Effect of thyroid function on number of Na-K pumps in human skeletal muscle", Lancet, 2, pp.8~10 (1984)
- Lin SH, "Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis", Am J Kidney Dis, 37, pp.620~623 (2001)
- Guerra M, "Androgens stimulate preoptic area Na+, K+-ATPase activity in male rats", Neurosci Lett, 78, pp.97~100 (1987)
- Kung AW, "Clinical review: thyrotoxic periodic paralysis:a diagnostic challenge", J Clin Endocrinol Metab, 91, pp.2490~2495 (2006)
- Chang CC, "A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants", Eur J Endocrinol, 169, pp.529~536 (2013)
- Trifanescu RA, "Hypokalemic periodic paralysis as first sign of thyrotoxicosis", J Med Life, 6, pp.72~75 (2013)
- Valizadeh N, "A 32-year-old man with normokalemic thyrotoxic periodic paralysis", Malays J Med Sci, 20, pp.81~83 (2013)
- Lin SH, "A simple and rapid approach to hypokalemic paralysis", Am J Emerg Med, 21, pp.487~491 (2003)
- Ahmed I, "Fatal dysrhythmia following potassium replacement for hypokalemic periodic paralysis", West J Emerg Med, 11, pp.57~59 (2010)
- Cope TE, "Thyrotoxic periodic paralysis: correct hypokalemia with caution", J Emerg Med, 45, pp.338~340 (2013)