Thyrotoxic periodic paralysis, a series of cases
Background: Thyrotoxic periodic paralysis (TPP) is a rare but dangerous complication observed in thyrotoxic patients, where a clinical presentation of muscle compromise common in channelopathies occurs. Objective: The objective of the study was to present 2 clinical cases of patients who presented P...
- Autores:
-
Bustos-Sánchez, José Luis
GUERRA GUERRA, LUISA IVONNE
Penagos Martínez, Iván Andrés
Núñez Mesa, Jeisson Steven
Vargas Rodríguez, Ledmar Jovanny
- Tipo de recurso:
- Article of investigation
- Fecha de publicación:
- 2024
- Institución:
- Universidad de Ciencias Aplicadas y Ambientales U.D.C.A
- Repositorio:
- Repositorio Institucional UDCA
- Idioma:
- eng
- OAI Identifier:
- oai:repository.udca.edu.co:11158/5750
- Acceso en línea:
- https://repository.udca.edu.co/handle/11158/5750
https //doi.org/10.1016/j.neuarg.2024.04.003
- Palabra clave:
- 610 - Medicina y salud
Tirotoxicosis
Parálisis
Hipopotasemia
Hipertiroidismo
Arreflexia
- Rights
- openAccess
- License
- https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.es
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Thyrotoxic periodic paralysis, a series of cases |
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Parálisis periódica tirotóxica, una serie de casos |
| title |
Thyrotoxic periodic paralysis, a series of cases |
| spellingShingle |
Thyrotoxic periodic paralysis, a series of cases 610 - Medicina y salud Tirotoxicosis Parálisis Hipopotasemia Hipertiroidismo Arreflexia |
| title_short |
Thyrotoxic periodic paralysis, a series of cases |
| title_full |
Thyrotoxic periodic paralysis, a series of cases |
| title_fullStr |
Thyrotoxic periodic paralysis, a series of cases |
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Thyrotoxic periodic paralysis, a series of cases |
| title_sort |
Thyrotoxic periodic paralysis, a series of cases |
| dc.creator.fl_str_mv |
Bustos-Sánchez, José Luis GUERRA GUERRA, LUISA IVONNE Penagos Martínez, Iván Andrés Núñez Mesa, Jeisson Steven Vargas Rodríguez, Ledmar Jovanny |
| dc.contributor.author.none.fl_str_mv |
Bustos-Sánchez, José Luis GUERRA GUERRA, LUISA IVONNE Penagos Martínez, Iván Andrés Núñez Mesa, Jeisson Steven Vargas Rodríguez, Ledmar Jovanny |
| dc.subject.ddc.none.fl_str_mv |
610 - Medicina y salud |
| topic |
610 - Medicina y salud Tirotoxicosis Parálisis Hipopotasemia Hipertiroidismo Arreflexia |
| dc.subject.decs.none.fl_str_mv |
Tirotoxicosis Parálisis Hipopotasemia Hipertiroidismo |
| dc.subject.proposal.none.fl_str_mv |
Arreflexia |
| description |
Background: Thyrotoxic periodic paralysis (TPP) is a rare but dangerous complication observed in thyrotoxic patients, where a clinical presentation of muscle compromise common in channelopathies occurs. Objective: The objective of the study was to present 2 clinical cases of patients who presented PPT. Clinical cases: Case 1: A 31-year-old male patient, with a progressive picture of asthenia, cramps, decreased muscle strength in the 4 extremities with greater involvement of the lower extremities, gait slower than usual, and tremor over the course of 4 days distal postural position in all 4 extremities, not triggered by any physical activity or stressful situation. Case 2: A 25-year-old male patient, with a 3-day progression of weakness in the 4 extremities, with a greater predominance in the lower extremities associated with myalgia in the thighs and calves, not triggered by any physical activity or stressful situation. Conclusion: In the cases presented, the patients reported hypokalemia and uncontrolled hyperthyroidism in the paraclinical tests, so it was decided to perform management with K+ replacement to prevent rebound hyperkalemia and β blockers, with which an adequate evolution was obtained, concluding that it presented with PPT. This pathological entity should be suspected in patients with thyrotoxicosis, hypokalemia, and sudden proximal symmetric muscle weakness of the lower extremities. |
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2024 |
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2024-05-27T19:47:39Z |
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2024-05-27T19:47:39Z |
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2024 |
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Artículo de revista |
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Sánchez, J. L. B., Guerra, L. I. G., Martínez, I. A. P., Mesa, J. S. N., & Rodríguez, L. J. V. (2024). Parálisis periódica tirotóxica, una serie de casos. Neurología Argentina. https://doi.org/10.1016/j.neuarg.2024.04.003 |
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18530028 |
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https://repository.udca.edu.co/handle/11158/5750 |
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https //doi.org/10.1016/j.neuarg.2024.04.003 |
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Sánchez, J. L. B., Guerra, L. I. G., Martínez, I. A. P., Mesa, J. S. N., & Rodríguez, L. J. V. (2024). Parálisis periódica tirotóxica, una serie de casos. Neurología Argentina. https://doi.org/10.1016/j.neuarg.2024.04.003 18530028 |
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https://repository.udca.edu.co/handle/11158/5750 https //doi.org/10.1016/j.neuarg.2024.04.003 |
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eng |
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Neurologia Argentina |
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Bustos-Sánchez, José LuisGUERRA GUERRA, LUISA IVONNEvirtual::41-1Penagos Martínez, Iván AndrésNúñez Mesa, Jeisson StevenVargas Rodríguez, Ledmar Jovannyvirtual::42-12024-05-27T19:47:39Z2024-05-27T19:47:39Z2024Sánchez, J. L. B., Guerra, L. I. G., Martínez, I. A. P., Mesa, J. S. N., & Rodríguez, L. J. V. (2024). Parálisis periódica tirotóxica, una serie de casos. Neurología Argentina. https://doi.org/10.1016/j.neuarg.2024.04.00318530028https://repository.udca.edu.co/handle/11158/5750https //doi.org/10.1016/j.neuarg.2024.04.003Background: Thyrotoxic periodic paralysis (TPP) is a rare but dangerous complication observed in thyrotoxic patients, where a clinical presentation of muscle compromise common in channelopathies occurs. Objective: The objective of the study was to present 2 clinical cases of patients who presented PPT. Clinical cases: Case 1: A 31-year-old male patient, with a progressive picture of asthenia, cramps, decreased muscle strength in the 4 extremities with greater involvement of the lower extremities, gait slower than usual, and tremor over the course of 4 days distal postural position in all 4 extremities, not triggered by any physical activity or stressful situation. Case 2: A 25-year-old male patient, with a 3-day progression of weakness in the 4 extremities, with a greater predominance in the lower extremities associated with myalgia in the thighs and calves, not triggered by any physical activity or stressful situation. Conclusion: In the cases presented, the patients reported hypokalemia and uncontrolled hyperthyroidism in the paraclinical tests, so it was decided to perform management with K+ replacement to prevent rebound hyperkalemia and β blockers, with which an adequate evolution was obtained, concluding that it presented with PPT. This pathological entity should be suspected in patients with thyrotoxicosis, hypokalemia, and sudden proximal symmetric muscle weakness of the lower extremities.nIntroducción: La parálisis periódica tirotóxica (PPT) es una complicación poco común, peropeligrosa que se observa en pacientes tirotóxicos, en quienes se produce una presentaciónclínica de compromiso muscular común en canalopatías.Objetivo: El objetivo del estudio fue presentar 2 casos clínicos de pacientes con PPT.Casos clínicos: Caso 1: Paciente masculino de 31 a˜nos, con cuadro progresivo de 4 días deevolución de astenia, calambres, disminución de la fuerza muscular en las 4 extremida-des con mayor compromiso de extremidades inferiores, marcha más lenta de lo habitualy temblor postural distal en las 4 extremidades, no desencadenado por actividad física nisituación estresante. Caso 2: Paciente masculino de 25 a˜nos, con cuadro progresivo de 3días de evolución, de debilidad en las 4 extremidades de mayor predominio en extremida-des inferiores asociada a mialgias en muslos y pantorrillas, no desencadenado por actividadfísica ni situación estresante.Conclusión: En los casos presentados los pacientes reportaron en los paraclínicos hipopotase-mia e hipertiroidismo no controlado, por lo cual se decidió realizar manejo con reemplazode K+para prevenir la hiperpotasemia de rebote y bloqueadores , con lo que se obtuvouna adecuada evolución, y se concluyó que cursaba con PPT. Esta entidad patológica debesospecharse en pacientes con tirotoxicosis, hipopotasemia y debilidad muscular simétricaproximal súbita de las extremidades inferiores.Incluye referencias bibliográficasapplication/pdfenghttps://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.eshttps://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_abf2https://www.elsevier.es/es-revista-neurologia-argentina-301-articulo-paralisis-periodica-tirotoxica-una-serie-S1853002824000235610 - Medicina y saludTirotoxicosisParálisisHipopotasemiaHipertiroidismoArreflexiaThyrotoxic periodic paralysis, a series of casesParálisis periódica tirotóxica, una serie de casosArtículo de 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jecuta públicamente en forma digital la Obra o cualquier Obra Derivada u Obra Colectiva, Usted debe mantener intacta toda la información de derecho de autor de la Obra y proporcionar, de forma razonable según el medio o manera que Usted esté utilizando: (i) el nombre del Autor Original si está provisto (o seudónimo, si fuere aplicable), y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.</li>
      <li>
        Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:
        <ol type="i">
          <li>Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.</li>
          <li>Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, los consagrados por la SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.</li>
        </ol>
      </li>
      <li>Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, ACINPRO), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.</li>
    </ol>
  </li>
  <br/>
  <li>
    Representaciones, Garantías y Limitaciones de Responsabilidad.
    <p>A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.</p>
  </li>
  <br/>
  <li>
    Limitación de responsabilidad.
    <p>A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.</p>
  </li>
  <br/>
  <li>
    Término.
    <ol type="a">
      <li>Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.</li>
      <li>Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.</li>
    </ol>
  </li>
  <br/>
  <li>
    Varios.
    <ol type="a">
      <li>Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.</li>
      <li>Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.</li>
      <li>Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.</li>
      <li>Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.</li>
    </ol>
  </li>
  <br/>
</ol>
 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