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      Paralisia periódica hipocalêmica como primeiro sintoma de hipertireoidismo: relato de caso Translated title: Thyrotoxic periodic paralysis as first manifestation of hyperthyroidism: case report

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          Abstract

          Relatamos caso de hipertireoidismo em um homem de 37 anos, no qual a paralisia periódica hipocalêmica apresentou-se como primeiro sintoma desta patologia. Abordamos aspectos do diagnóstico diferencial com outras formas de paralisia periódica e destacamos a necessidade de realizar um correto diagnóstico desta patologia, a fim de evitar complicações clínicas e degeneração muscular permanente.

          Translated abstract

          We report a case of thyrotoxicosis in a 37 year old male, in whom hypocalemic periodic paralysis was the first manifestation of the disease. We comment about the differential diagnosis with other types of periodic paralysis, and the importance of a correct diagnosis to avoid permanent muscle damage.

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          Most cited references13

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          Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature.

          Although hypokalemic periodic paralysis is a common complication of hyperthyroidism among Asian populations, it is an uncommon problem in the United States. The recent experience in an American medical center with 7 patients with thyrotoxic periodic paralysis (TPP) is reviewed. Compared to most descriptions of this disorder, which tend to reflect the international experience with this disease, patients with TPP in the United States reflect the ethnic makeup of the local population: the predisposition of patients of Asian origin is very evident, but whites are more frequently affected than most previous reports have recognized. Hispanics and American Indians also appear to be at increased risk, and blacks have also been affected. Except for the fact that hyperthyroidism is an absolute requirement for expression of the disease, TPP is identical to familial periodic paralysis (FPP) in its clinical presentation. TPP affects predominantly males (to an even greater degree than FPP), is rarely associated with a positive family history, and has a later onset of presentation than FPP (reflecting the need for hyperthyroidism to occur before the disorder can be expressed). Graves disease is the most common cause of hyperthyroidism in affected patients, but any cause of thyrotoxicosis (including administration of excessive amounts of exogenous thyroid hormone) can trigger attacks of TPP in susceptible subjects. Clinical features of thyroid disease may be very subtle or virtually nonexistent; as a result, thyroid function tests should be routinely monitored in patients with features of hypokalemic paralysis. The pathophysiology of the disorder is not well understood. Definitive treatment of hyperthyroidism leads to cessation of periodic hypokalemic paralysis, but symptoms can return with recurrence of the hyperthyroid condition. Potassium administration during an acute attack will shorten the duration of the episode, and treatment with propranolol, potassium supplementation, or spironolactone may prevent attacks in some patients.
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            Periodic paralysis and the sodium-potassium pump.

            R Layzer (1982)
            Analysis of the pathophysiology of hypokalemic paralysis, as it occurs in barium poisoning, chronic potassium deficiency, and thyrotoxicosis, suggests that these disorders may have a similar mechanism. An increased ratio of muscle sodium permeability to potassium permeability reduces the ionic diffusion potential, while the resting membrane potential is sustained by an increase of Na-K pump electrogenesis. The result is that potassium entry (the sum of active and passive influx) exceeds potassium efflux; this causes a large shift of extracellular potassium into muscle until the Na-K pump turns off, leading to depolarization and paralysis. The primary defect in familial hypokalemic periodic paralysis, as in the example of barium poisoning, may be a marked reduction of muscle permeability to potassium.
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              Merrit's neurology

              LP Rowland (2000)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                anp
                Arquivos de Neuro-Psiquiatria
                Arq. Neuro-Psiquiatr.
                Academia Brasileira de Neurologia - ABNEURO (São Paulo )
                1678-4227
                June 2002
                : 60
                : 2B
                : 490-492
                Affiliations
                [1 ] Hospital Santa Rosa Brazil
                Article
                S0004-282X2002000300029
                10.1590/S0004-282X2002000300029
                2adf3568-7577-4e0c-80bd-4d02501fceca

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-282X&lng=en
                Categories
                NEUROSCIENCES
                PSYCHIATRY

                Neurosciences,Clinical Psychology & Psychiatry
                hypocalemic periodic paralysis,thyrotoxicosis,paralisia periódica hipocalêmica,hipertireoidismo

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