PARALISIA PERIÓDICA HIPOCALIÉMICA – UMA CAUSA RARA DE TETRAPARÉSIA EM EUROPEUS | HYPOKALAEMIC PERIODIC PARALYSIS – A RARE CAUSE OF TETRAPARESIS IN EUROPEAN PEOPLE
2015
PT: A paralisia periodica hipocaliemica e uma complicacao neurologica do hipertiroidismo, especialmente na doenca de Gra- ves, rara em nao asiaticos. Caracteriza-se por episodios auto-limitados recorrentes de fraqueza muscular que afecta sobretu- do os musculos proximais dos membros inferiores. Acompanha-se de hipocaliemia, potencialmente grave. Apresenta-se o caso de um doente de 39 anos, caucasiano, com doenca de Graves, medicado com carbimazol. Durante 3 meses, teve episodios recorrentes de tetraparesia de predominio proximal, de curta duracao, que surgiam apos periodos de repouso, motivo pelo qual foi internado. Por manter episodios de agravamento da tetraparesia, associados a hipocalie- mia e hipomagnesiemia, e por, laboratorialmente, apresentar hipertiroidismo, admitiu-se a hipotese de paralisia periodica hipocaliemica e iniciou terapeutica com tiamazol, corticoterapia, propranolol e reposicao ionica, verificando-se melhoria progressiva. O caso exposto e um exemplo de uma situacao incomum, em que a suspeita clinica e fundamental, porque o diagnostico pode ser dificil. A terapeutica precoce do hipertiroidismo e imprescindivel. Palavras-chave: Hipertiroidismo; Doenca de Graves; Paralisia periodica hipocaliemica. EN: Hypokalaemic periodic paralysis is a neurological complication of hyperthyroidism, especially in Graves disease, rare in non-Asiatic peo- ple. This condition is characterized by recurrent self-limited episodes of muscular weakness, which mostly affects proximal muscles of lower extremities. It may be accompanied by hypokalaemia, eventually severe. We present a case of a 39-year-old male patient, Caucasian, with Graves disease, treated with carbimazole. Over the previous 3 months, he had had recurrent episodes of tetraparesis with proximal predominance, within short periods, which emerged after rest. For that reason he was hospitalised. Because he still had worsening episodes of tetraparesis, with hypokalaemia and hypomagnesaemia, and hyperthyroidism, we admitted the diagnostic hypothesis of hypokalaemic periodic paralysis. Therefore, he initiated thiamazole, corticotherapy, propranolol and ion replacement, having progressive improvement. This case is an example of an uncommon situation, in which clinical suspicion is fundamental, because diagnosis can be difficult. Early treatment of hyperthyroidism is imperative. Key words: Hyperthyroidism; Graves disease; Hypokalemic periodic paralysis.
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