KELUMPUHAN BERKALA TIROTOKSIK PADA ANAK: LAPORAN KASUS
Keywords:
Kelumpuhan Periodik Tirotoksik, Hipertiroidisme, Hipokalemia
Abstract
Kelumpuhan Periodik Tirotoksik (TPP) adalah kelainan langka yang ditandai dengan timbulnya kelemahan otot secara tiba-tiba dan episode hipokalemia dengan tirotoksikosis. TPP umumnya ditemukan pada pria berusia 20-40 tahun di Asia.1 TPP adalah kondisi reversibel yang dapat ditangani dengan koreksi kalium dan normalisasi hormon tiroid. Peningkatan aktivitas pompa Na-K ATPase dan mutasi pada gen yang mengkode saluran kiri pada otot rangka merupakan teori yang dapat menjelaskan terjadinya TPP.2 Kelemahan otot yang dapat berkembang menjadi kelumpuhan akibat hipokalemia dianggap sebagai keadaan darurat medis. Hipokalemia dapat terjadi akibat hilangnya K+ di ginjal atau saluran cerna atau akibat pergeseran K+ ke dalam sel yang disebabkan oleh gangguan asam basa atau distimulasi oleh obat-obatan atau hormon endogen.3 Laporan kasus ini menggambarkan seorang anak laki-laki berusia 17 tahun yang mengalami kelumpuhan akut yang disertai tanda dan gejala hipertiroidisme.
References
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9. Chang CC, Cheng CJ, Sung CC, Chiueh TS, Lee CH, Chau T, Lin SH. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants. Eur J Endocrinol. 2013 Oct 1;169(5):529-36. doi: 10.1530/EJE-13-0381. PMID: 23939916; PMCID: PMC3789562.
10. McFadzean AJ, Yeung R. Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J. 1967 Feb 25;1(5538):451-5. doi: 10.1136/bmj.1.5538.451. PMID: 6017520; PMCID: PMC1840834.
11. Fontaine B, Lapie P, Plassart E, Tabti N, Nicole S, Reboul J, Rime-Davoine CS. Periodic paralysis and voltage-gated ion channels. Kidney Int. 1996 Jan;49(1):9-18. doi: 10.1038/ki.1996.2. PMID: 8770943.
12. Wong P. Hypokalemic thyrotoxic periodic paralysis: a case series. CJEM. 2003 Sep;5(5):353-5. PMID: 17466146.
13. Hagel S, Elznerova T, Dietrich W, Schrauzer T, John S. Chest pain and paralysis after pulse prednisolone therapy an unusual case presentation of thyrotoxic periodic paralysis: a case report. Cases J. 2009 Aug 25;2:7501. doi: 10.4076/1757-1626-2-7501. PMID: 19918467; PMCID: PMC2769357.
14. Yeh FC, Chiang WF, Wang CC, Lin SH. Thyrotoxic periodic paralysis triggered by β2-adrenergic bronchodilators. CJEM. 2014 May;16(3):247-51. doi: 10.2310/8000.2013.130867. PMID: 24852589.
15. Yu TS, Tseng CF, Chuang YY, Yeung LK, Lu KC. Potassium chloride supplementation alone may not improve hypokalemia in thyrotoxic hypokalemic periodic paralysis. J Emerg Med. 2007 Apr;32(3):263-5. doi: 10.1016/j.jemermed.2006.06.009. Epub 2007 Feb 7. PMID: 17394988.
16. Lopez S, Henderson SO. Electrocardiogram changes in Thyrotoxic Periodic Paralysis. West J Emerg Med. 2012 Dec;13(6):512-3. doi: 10.5811/westjem.2011.11.12127. PMID: 23359336; PMCID: PMC3555582.
17. Manoukian MA, Foote JA, Crapo LM. Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med. 1999 Mar 22;159(6):601-6. doi: 10.1001/archinte.159.6.601. PMID: 10090117.
18. Li J, Yang XB, Zhao Y. Thyrotoxic periodic paralysis in the Chinese population: clinical features in 45 cases. Exp Clin Endocrinol Diabetes. 2010 Jan;118(1):22-6. doi: 10.1055/s-0028-1112150. PMID: 20162834.
19. Weber F, Lehmann-Horn F. Hypokalemic Periodic Paralysis. 2002 Apr 30 [updated 2018 Jul 26]. In: Adam MP, Everman DB, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2023. PMID: 20301512.
20. Levitt J. O. (2008). Practical aspects in the management of hypokalemic periodic paralysis. Journal of translational medicine, 6, 18. https://doi.org/10.1186/1479-5876-6-18
21. Lu KC, Hsu YJ, Chiu JS, Hsu YD, Lin SH. Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis. Am J Emerg Med. 2004 Nov;22(7):544-7. doi: 10.1016/j.ajem.2004.09.016. PMID: 15666258.
22. Vijayakumar, A., Ashwath, G., & Thimmappa, D. (2014). Thyrotoxic periodic paralysis: clinical challenges. Journal of thyroid research, 2014, 649502. https://doi.org/10.1155/2014/649502
23. Birkhahn RH, Gaeta TJ, Melniker L. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med. 2000 Feb;18(2):199-202. doi: 10.1016/s0736-4679(99)00194-8. PMID: 10699522.
24. Yu TS, Tseng CF, Chuang YY, Yeung LK, Lu KC. Potassium chloride supplementation alone may not improve hypokalemia in thyrotoxic hypokalemic periodic paralysis. J Emerg Med. 2007 Apr;32(3):263-5. doi: 10.1016/j.jemermed.2006.06.009. Epub 2007 Feb 7. PMID: 17394988.
25. Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis. 2001 Mar;37(3):620-3. PMID: 11228188.
26. Chang RY, Lang BH, Chan AC, Wong KP. Evaluating the efficacy of primary treatment for graves' disease complicated by thyrotoxic periodic paralysis. Int J Endocrinol. 2014;2014:949068. doi: 10.1155/2014/949068. Epub 2014 Aug 3. PMID: 25147568; PMCID: PMC4131447.
27. Rhee EP, Scott JA, Dighe AS. Case records of the Massachusetts General Hospital. Case 4-2012. A 37-year-old man with muscle pain, weakness, and weight loss. N Engl J Med. 2012 Feb 9;366(6):553-60. doi: 10.1056/NEJMcpc1110051. PMID: 22316449.
28. Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore). 1992 May;71(3):109-20. doi: 10.1097/00005792-199205000-00001. PMID: 1635436.
29. Ptácek L. The familial periodic paralyses and nondystrophic myotonias. Am J Med. 1998 Jul;105(1):58-70. doi: 10.1016/s0002-9343(98)00123-5. PMID: 9688022.
30. Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab. 2006 Jul;91(7):2490-5. doi: 10.1210/jc.2006-0356. Epub 2006 Apr 11. PMID: 16608889.
2. Siddamreddy S, Dandu V. Thyrotoxic Periodic Paralysis. StatPearls. 2021
3. Lin S, Huang C. Mechanism of Thyrotoxic Periodic Paralysis. JASN. 2012
4. Phuyal P, Nagalli S. Hypokalemic Periodic Paralysis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559178/
5. Garla, Vishnu & Gunturu, Manasa & Kovvuru, Karthik & Abdul Salim, Sohail. (2018). Thyrotoxic periodic paralysis: case report and review of the literature. Electronic Physician. 10. 7174-7179. 10.19082/7174.
6. Patel M, Ladak K. Thyrotoxic Periodic Paralysis: A Case Report and Literature Review. Clin Med Res. 2021 Sep;19(3):148-151. doi: 10.3121/cmr.2021.1610. PMID: 34531272; PMCID: PMC8445659.
7. Hsieh MJ, Lyu RK, Chang WN, Chang KH, Chen CM, Chang HS, Wu YR, Chen ST, Ro LS. Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks. Eur J Neurol. 2008 Jun;15(6):559-64. doi: 10.1111/j.1468-1331.2008.02132.x. Epub 2008 Apr 10. PMID: 18410374.
8. Venance SL, Cannon SC, Fialho D, Fontaine B, Hanna MG, Ptacek LJ, Tristani-Firouzi M, Tawil R, Griggs RC; CINCH investigators. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain. 2006 Jan;129(Pt 1):8-17. doi: 10.1093/brain/awh639. Epub 2005 Sep 29. PMID: 16195244.
9. Chang CC, Cheng CJ, Sung CC, Chiueh TS, Lee CH, Chau T, Lin SH. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants. Eur J Endocrinol. 2013 Oct 1;169(5):529-36. doi: 10.1530/EJE-13-0381. PMID: 23939916; PMCID: PMC3789562.
10. McFadzean AJ, Yeung R. Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J. 1967 Feb 25;1(5538):451-5. doi: 10.1136/bmj.1.5538.451. PMID: 6017520; PMCID: PMC1840834.
11. Fontaine B, Lapie P, Plassart E, Tabti N, Nicole S, Reboul J, Rime-Davoine CS. Periodic paralysis and voltage-gated ion channels. Kidney Int. 1996 Jan;49(1):9-18. doi: 10.1038/ki.1996.2. PMID: 8770943.
12. Wong P. Hypokalemic thyrotoxic periodic paralysis: a case series. CJEM. 2003 Sep;5(5):353-5. PMID: 17466146.
13. Hagel S, Elznerova T, Dietrich W, Schrauzer T, John S. Chest pain and paralysis after pulse prednisolone therapy an unusual case presentation of thyrotoxic periodic paralysis: a case report. Cases J. 2009 Aug 25;2:7501. doi: 10.4076/1757-1626-2-7501. PMID: 19918467; PMCID: PMC2769357.
14. Yeh FC, Chiang WF, Wang CC, Lin SH. Thyrotoxic periodic paralysis triggered by β2-adrenergic bronchodilators. CJEM. 2014 May;16(3):247-51. doi: 10.2310/8000.2013.130867. PMID: 24852589.
15. Yu TS, Tseng CF, Chuang YY, Yeung LK, Lu KC. Potassium chloride supplementation alone may not improve hypokalemia in thyrotoxic hypokalemic periodic paralysis. J Emerg Med. 2007 Apr;32(3):263-5. doi: 10.1016/j.jemermed.2006.06.009. Epub 2007 Feb 7. PMID: 17394988.
16. Lopez S, Henderson SO. Electrocardiogram changes in Thyrotoxic Periodic Paralysis. West J Emerg Med. 2012 Dec;13(6):512-3. doi: 10.5811/westjem.2011.11.12127. PMID: 23359336; PMCID: PMC3555582.
17. Manoukian MA, Foote JA, Crapo LM. Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med. 1999 Mar 22;159(6):601-6. doi: 10.1001/archinte.159.6.601. PMID: 10090117.
18. Li J, Yang XB, Zhao Y. Thyrotoxic periodic paralysis in the Chinese population: clinical features in 45 cases. Exp Clin Endocrinol Diabetes. 2010 Jan;118(1):22-6. doi: 10.1055/s-0028-1112150. PMID: 20162834.
19. Weber F, Lehmann-Horn F. Hypokalemic Periodic Paralysis. 2002 Apr 30 [updated 2018 Jul 26]. In: Adam MP, Everman DB, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2023. PMID: 20301512.
20. Levitt J. O. (2008). Practical aspects in the management of hypokalemic periodic paralysis. Journal of translational medicine, 6, 18. https://doi.org/10.1186/1479-5876-6-18
21. Lu KC, Hsu YJ, Chiu JS, Hsu YD, Lin SH. Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis. Am J Emerg Med. 2004 Nov;22(7):544-7. doi: 10.1016/j.ajem.2004.09.016. PMID: 15666258.
22. Vijayakumar, A., Ashwath, G., & Thimmappa, D. (2014). Thyrotoxic periodic paralysis: clinical challenges. Journal of thyroid research, 2014, 649502. https://doi.org/10.1155/2014/649502
23. Birkhahn RH, Gaeta TJ, Melniker L. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med. 2000 Feb;18(2):199-202. doi: 10.1016/s0736-4679(99)00194-8. PMID: 10699522.
24. Yu TS, Tseng CF, Chuang YY, Yeung LK, Lu KC. Potassium chloride supplementation alone may not improve hypokalemia in thyrotoxic hypokalemic periodic paralysis. J Emerg Med. 2007 Apr;32(3):263-5. doi: 10.1016/j.jemermed.2006.06.009. Epub 2007 Feb 7. PMID: 17394988.
25. Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis. 2001 Mar;37(3):620-3. PMID: 11228188.
26. Chang RY, Lang BH, Chan AC, Wong KP. Evaluating the efficacy of primary treatment for graves' disease complicated by thyrotoxic periodic paralysis. Int J Endocrinol. 2014;2014:949068. doi: 10.1155/2014/949068. Epub 2014 Aug 3. PMID: 25147568; PMCID: PMC4131447.
27. Rhee EP, Scott JA, Dighe AS. Case records of the Massachusetts General Hospital. Case 4-2012. A 37-year-old man with muscle pain, weakness, and weight loss. N Engl J Med. 2012 Feb 9;366(6):553-60. doi: 10.1056/NEJMcpc1110051. PMID: 22316449.
28. Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore). 1992 May;71(3):109-20. doi: 10.1097/00005792-199205000-00001. PMID: 1635436.
29. Ptácek L. The familial periodic paralyses and nondystrophic myotonias. Am J Med. 1998 Jul;105(1):58-70. doi: 10.1016/s0002-9343(98)00123-5. PMID: 9688022.
30. Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab. 2006 Jul;91(7):2490-5. doi: 10.1210/jc.2006-0356. Epub 2006 Apr 11. PMID: 16608889.
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