Seval İZDEŞ, Fevzi BALKAN, Bekir ÇAKIR, Eda ÖNAL DEMİR, Celil Alper USLUOĞULLARI, Reyhan ERSOY

Ventricular fibrillation due to severe hypokalemia in a patient with thyrotoxic periodic paralysis

Tirotoksik hipokalemik periyodik paralizi (TPP) hipertiroidinin nadir bir komplikasyonu olup, hipokalemi ve kas güçsüzlüğü atakları ileseyretmektedir. Klinik pratikte hipokalemi, normokalemi ya da hiperkalemi saptanabilir. Genellikle atakların oluşmasını tetikleyen stres, aşırıegzersiz, karbonhidrattan zengin beslenme gibi presipitan faktörler vardır. Atakların süresi ortalama 2-36 saat kadar olup gerekli durumlardapotasyum replasmanı ile bu süre daha da kısalmaktadır. Paralizi atakları dışında kişinin tamamen sağlıklı olduğu bir hastalıktır. Acilpolikliniğimize başvuran 31 yaşında kadın hastanın, bacaklarında ve kollarında güçsüzlük, yürüyememe şikayetleri mevcuttu. Anamnez velaboratuvar incelemeleri ile hastaya tirotoksik periyodik paralizi tanısı kondu. Tirotoksik periyodik paralizi nadir ancak hayatı tehdit edebilenbir klinik durumdur. Bu olgu sunumunda nadir olması nedeniyle tipik tirotoksik periyodik paralizi tanılı bir hasta literatür eşliğinde gözdengeçirilip sunulmuştur.

Tirotoksik hipokalemik periyodik paralizili bir hastada hipokaleminin tetiklediği ventriküler fibrilasyon

Hypokalemic thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism. It accompanies episodes of hypokalemia andmuscle weakness. In general, hypokalemia, normokalemia, and hyperkalemia can all be observed. There are generally some precipitatingfactors such as stress, vigorous exercise, and high carbohydrate consumption all of which make way for the occurrence of attacks. Theduration of attacks range from 2-36 hours and can be shortened by potassium supplementation. Except for attacks of paralysis, it is adisease that affects totally healthy people. A 31-year-old female patient was admitted to the emergency unit with the complaints ofbilateral lower and upper extremity weakness and paralysis. The patient s history and laboratory findings were consistent with our diagnosisof thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis is a rare but life-threatening clinical entity. We would like to present anuncommon case of thyrotoxic periodic paralysis and along with a review the literature.

PDF

___

1. Falhammar H, Thorén M, Calissendorff J. Thyrotoxic periodic paralysis: clinical and molecular aspects. Endocrine 2013;43:274-84.
2. Ko GT, Chow CC, Yeung VT, Chan HH, Li JK, Cockram CS. Thyrotoxic periodic paralysis in a Chinese population. QJM 1996;89:463-8.
3. Cesur M, Bayram F, Temel MA, Ozkaya M, Kocer A, Ertorer ME, ve ark. Thyrotoxic hypokalaemic periodic paralysis in a Turkish population: three new case reports and analysis of the case series. Clin Endocrinol (Oxf). 2008;68:143-52.
4. Aylin A, Remzi Y, Şebnem A, Sırma G, Derya S, Mustafa Y ve ark. Tirotoksik hipokalemik periyodik paralizi: Türk toplumunda dört yeni olgu. Türk Nörol Derg 2008;6:410-14.
5. Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore) 1992;71:109-20.
6. 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;149:2597-600.
7. Hsieh MJ, Lyu RK, Chang WN, Chang KH, Chen CM, Chang HS et al . Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks. Eur J Neurol 2008;15:559-64.
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;169:529-36.
9. Pompeo A, Nepa A, Maddestra M, Feliziani V, Genovesi N.Thyrotoxic hypokalemic periodic paralysis: An over looked pathology in western countries. Eur J Intern Med 2007;18:380-90.
10. Wang W, Jiang L, Ye L, Zhu N, Su T, Guan L, et al. Mutation screening in Chinese hypokalemic periodic paralysis patients. Mol Genet Metab. 2006;87:359-63.
11. Liu WH, Liu CD, Zhang JY. Association of HLA antigens with thyrotoxic periodic paralysis. Zhonghua Nei Ke Za Zhi. 1991;30:395-8,454.
12. Miyashita Y, Monden T, Yamamoto K, Matsumura M, Kawagoe N, Iwata C et al. Ventricular fibrillation due to severe hypokalemia induced by steroid treatment in a patient with thyrotoxic periodic paralysis. Intern Med. 2006;45:11-3.
13. Pothiwala P, Levine SN. Analytic review: thyrotoxic periodic paralysis: a review. J Intensive Care Med. 2010;25:71-7.
14. Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab. 2006;91:2490-5.
15. Tigas S, Papachilleos P, Ligkros N, Andrikoula M, Tsatsoulis A. Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy. Hormones (Athens). 2011;10:313-6.