Journal of Yeungnam Medical Science
- 제16권2호
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- Pages.228-236
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- 1999
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- 2799-8010(eISSN)
갑상선 중독성 주기성마비 환자의 임상적 고찰
Clinical Aspects in Patients with Thyrotoxic Periodic Hypokalemic Paralysis
- 남상엽 (영남대학교 의과대학 내과학교실) ;
- 김재홍 (영남대학교 의과대학 내과학교실) ;
- 오정현 (영남대학교 의과대학 내과학교실) ;
- 박진철 (영남대학교 의과대학 내과학교실) ;
- 윤현대 (영남대학교 의과대학 내과학교실) ;
- 원규장 (영남대학교 의과대학 내과학교실) ;
- 조인호 (영남대학교 의과대학 내과학교실) ;
- 성차경 (구미 차병원 내과) ;
- 이형우 (영남대학교 의과대학 내과학교실)
- Narn, Sang-Yob (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Kirn, Jae-Hong (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Oh, Jung-Hyn (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Park, Jin-Chul (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Yoon, Hyun-Dae (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Won, Kyu-Chang (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Cho, Ihn-Ho (Department of Internal Medicine, College of Medicine, Yeungnam University) ;
- Sung, Cha-Kyung (Kumi CHA General Hospital) ;
- Lee, Hyoung-Woo (Department of Internal Medicine, College of Medicine, Yeungnam University)
- 발행 : 1999.12.30
초록
저자들은 한국인 갑상선 기능 항진증에 동반된 주기성마비의 임상적 특정을 알아보고자 1986년 3월부터 1996년 3월까지 영남대학교 의과대학 부속 병원 내과에 내원하여 갑상선기능 항진증을 진단받은 환자 997명 중 주기성마비를 보였던 19명을 관찰하여 다음과 같은 결과를 얻었다. 대상환자 997명 중 남자는 296명, 여자는 701명이었고, 이들 중 주기성마비는 19명에서 발생하여 빈도는 1.9%이었다. 성별분포는 남자에서 6%(18/296), 여자에서는 0.2%(1/701)의 발생률을 보였다. 또한 마비가 시작된 연령은 19 - 55세로서 평균 35세이었다. 마비는 주로 하지(14/19, 73.6%)에 일어났고, 상하지 모두에서 발생한 경우도 3명(15.7%)이었으나, 상지만 발생된 경우는 없었다. 그리고 원위부보다 근위부에 더 심한 마비를 보였다. 총 19명의 대상환자들 중 6명(38.5%)의 환자에서는 선행 유발요인을 찾을 수 없었으나 나머지 환자들에서는 과식(5/19, 26.3%), 음주(3/19, 15.7%), 육체적 과로(4/19, 21%), 감염(1/19, 5.2%) 등이 유발요인으로 작용하였다. 19명의 환자의 마비발작시 혈중 칼륨 수치는 1.5-6.1(평균
Background: Thyrotoxic periodic paralysis is an uncommon illness characterized by intermittent flaccid paralysis of skeletal muscle, usually accompanied by hypokalemia, in patient with hyperthyroidism. However, the pathophysiology of thyrotoxic periodic paralysis remains largely unexplained and controversial. This report describes the clinical and biochemical findings in 19 patients with thyrotoxic periodic paralysis who were examined at the Yeungnam University Medical Center(YUMC) during the past decade. Methods: The medical records of 997 YUMC patients, seen between 1986 and 1996, with diagnosis of hyperthyroidism were reviewed. Nineteen patients out of 997 hyperthyroidism patients were diagnosed, and examined by history, physical examination, serum electrolyte value, and thyroid function test during paralysis. On the basis of these results, comparisons were made on age, sex, precipitating factors, timing, affected limbs, prognosis, serum potassium and serum phosphate and thyroid hormone levels. Results: The prevalence of periodic paralysis in hyperthyroidism was 1.9 percent and the male to female prevalence ratio was 30:1 and in all patients, the development of perodic paralysis was correlated with hyperfunctional state of the thyroid gland. Eleven cases of periodic paralysis were associated with hypokalemia and their thyroid hormone levels were significantly more increased than those of the patients without hypokalemia. Interestingly, our study shows the recurrence of paralysis after treatment. Conclusion: Although the precise pathophysiology of the disease is as yet undefined and controversial, it occurs primarily in Asians with an overwhelming male preponderance and prevalence of 2 percent in hyperthyroidism. The interactive roles of thyroid hormone, Na-K pump, and genetically inherited defect in the cellular membrane potential of the skeletal muscle can be speculated. Further investigation will be needed to firmly establish the mechanism of thyrotoxic periodic paralysis.