頁籤選單縮合
題 名 | 甲狀腺毒性週期性麻痺症之13例分析=Thyrotoxic Periodic Paralysis: Analysis of 13 Cases |
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作 者 | 高肇隆; 杜思德; 蘇矢立; | 書刊名 | 內科學誌 |
卷 期 | 13:1 2002.02[民91.02] |
頁 次 | 頁22-26 |
分類號 | 415.931 |
關鍵詞 | 甲狀腺毒性週期性麻痺症; 葛瑞芙茲氏病; 低血鉀症; Thyrotoxic periodic paralysis; Graves' disease; Hypokalemia; |
語 文 | 中文(Chinese) |
中文摘要 | 甲狀腺毒性週期性麻痺症 (thyrotoxic periodic paralysis, TPP) 是以甲狀腺機能亢進 , 低血鉀症及突發性肌肉無力為主要表現的症候群,並且特別好發於東方人。但是因為這種病例並不多見,所以大部份的醫師在面對低血鉀症合併肢體麻痺時,通常都忽略了應考慮到甲狀腺毒性週期性麻痺症的可能,因此沒有檢查患者是否有潛在的甲狀腺機能異常情形,而造成誤診。有鑑於此,為了增加對於本土性的甲狀腺毒性週期性麻痺症的了解,我們回顧了財團法人彰化基督教醫院從1996 年 8 月到 2001 年 8 月間的所有經診斷為甲狀腺毒性週期性麻痺症或同時併有診斷為甲狀腺機能亢進(hyperthyroidism),低血鉀症(hypokalemia) 及肢體麻痺 (limb paralysis) 之病例共13例,經分析後發現,該症候群在性別上好發於男性 ( 男:女=8:5),年齡分佈上多見於年輕人( 主要分佈於 23 至 44 歲 ),而且好發於夏、秋兩季 (5月至9月),病人入院時之平均鉀離子濃度為 2.04mmol/L,但經過適當的鉀離子補充後,只有一個病例之血中鉀離濃超過5.Ommol/L;大部份甲狀腺機能亢進的原因仍是葛瑞英茲氏病 (Graves' disease);大部份的病人出現肢體麻痺現象多局限於下肢;但亦有小部份發生在四肢或局限於上肢,臉部的侵犯則沒有發現,且大多數病患麻痺的程度皆屬嚴重。結論:對台灣地區之年輕男性出現急性肢體麻痺現象時,甲狀腺毒性週期性麻痺症應被列入考慮,而且,患者若無甲狀腺機能亢進之症狀時,亦不能排除其發生之可能,因為患者有時只是亞臨床甲狀腺機能亢進(subclinical hyperthyroidism)。在治療方面,積極的鉀離子補充及監測是很重要的,畢竟反彈性高血鉀症在國外的病例中,屢有報告,雖然在我們的病例中,只有1例是輕微的血鉀過高,但仍不能忽視。 |
英文摘要 | We retrospectively evaluated the clinical and biochemical characteristics in 13 adult patients admitted with thyrotoxic hypokalemic periodic paralysis in Changhua, Taiwan from 1996 to 2001. Thirteen Chinese adult patients were admitted with acute limb weakness, plasma potassium less than or equal to 3.5 mmol/L and thyrotoxicosis confirmed by laboratory investigations. Male to female ratio is 8 to 5 and age distribution is from 23 to 70 y/o but about two- thirds of patients are around 23 to 44 y/o. About two-thirds of the attacks occurred between May and September ( 77 percent ), most commonly in June ( 38.4 percent). Mean plasma potassium on admission was 2.04 mmol/L ( range 1.4-3.1 ). In one episode ( 7.7 percent ), plasma potassium on recovery exceeded 5.0 mmol/L. No patient had a positive family history of thyrotoxic periodic paralysis. The underlying causes of thyrotoxicosis are Graves' disease (11 cases ), subacute thyroiditis (1 case ) , and toxic adenoma ( 1 case ). Most patients have severe paralysis ( 10 cases) and fewer patients have moderate paralysis ( 3 cases ). The location of TPP attack is most common at lower ( 8 cases) and whole ( 4 cases) limbs and fewer at upper limbs (1 case ). No facial paralysis was noted. The diagnosis of thyrotoxic hypokalemic paralysis should always be considered in Chinese patients with acute muscle weakness, especially in young males. Absence of clinical thyrotoxicosis does not exclude the diagnosis. Plasma potassium should be monitored carefully during treatment to prevent rebound hyperkalemia. (J Intern Med Taiwan 2002; 13: 22-26 ) |
本系統中英文摘要資訊取自各篇刊載內容。