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9 "Paralysis"
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Original Article
Clinical Study
Efficacy of Intraoperative Neuromonitoring in Reoperation for Recurrent Thyroid Cancer Patients
Jang-il Kim, Su-jin Kim, Zhen Xu, JungHak Kwak, Jong-hyuk Ahn, Hyeong Won Yu, Young Jun Chai, June Young Choi, Kyu Eun Lee
Endocrinol Metab. 2020;35(4):918-924.   Published online December 23, 2020
DOI: https://doi.org/10.3803/EnM.2020.778
  • 4,760 View
  • 109 Download
  • 6 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
The use of intraoperative neuromonitoring (IONM) in thyroid surgery to preserve recurrent laryngeal nerve (RLN) function has been widely accepted. We aimed to evaluate the usefulness of IONM in reoperation for recurrent thyroid cancer patients to help identify the RLN and prevent vocal cord palsy (VCP).
Methods
We analyzed 121 consecutive patients (with IONM group, 48 patients; without IONM group, 73 patients) who underwent reoperation for recurrent thyroid cancer after total thyroidectomy from January 2009 to March 2019 in our institution without VCP due to previous operations. Data including age, sex, number of previous operations, histologic subtype of the malignancy at the initial operation, operation time, RLNs at risk, difficulty of RLN identification, surgical procedure, VCP, and other postoperative complications were reviewed. Vocal cord movement evaluations were performed preoperatively and at 2 weeks postoperatively to evaluate RLN function. In patients with VCP, additional evaluations were performed. VCP exceeding 12 months after surgery was considered permanent VCP.
Results
VCP was observed in six (12.5%) and 16 (21.9%) patients with and without IONM (P=0.189). Transient and permanent VCP were found in three (6.3%) and three (6.3%) patients with IONM (P=0.098 and P=0.982, respectively) versus in 12 (16.4%) and four (5.5%) patients without IONM.
Conclusion
The incidence of transient VCP seems to be lower in reoperations with IONM; however, there was no statistical significances. Further study will be needed to ascertain the efficacy of IONM in reoperation for recurrent thyroid cancer patients.

Citations

Citations to this article as recorded by  
  • Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis
    Andrew Saxe, Mohamed Idris, Jickssa Gemechu
    Diagnostics.2024; 14(9): 860.     CrossRef
  • The learning curve for gasless transaxillary posterior endoscopic thyroidectomy for thyroid cancer: a cumulative sum analysis
    Weisheng Chen, Shitong Yu, Baihui Sun, Cangui Wu, Tingting Li, Shumin Dong, Junna Ge, Shangtong Lei
    Updates in Surgery.2023; 75(4): 987.     CrossRef
  • Intraoperative neuromonitoring of the recurrent laryngeal nerve is indispensable during complete endoscopic radical resection of thyroid cancer: A retrospective study
    Yang Fei, Yang Li, Feng Chen, Wen Tian
    Laryngoscope Investigative Otolaryngology.2022; 7(4): 1217.     CrossRef
  • The value of intraoperative nerve monitoring against recurrent laryngeal nerve injury in thyroid reoperations
    Maowei Pei, Siqi Zhu, Chunjie Zhang, Guoliang Wang, Mingrong Hu
    Medicine.2021; 100(51): e28233.     CrossRef
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Case Report
A Case of Thyrotoxic Hypokalemic Periodic Paralysis Presenting as Cardiac Arrest.
Chang Ho Song, Choon Hee Chung, Young Joon Weon, Mi Deok Lee, Seong Jin Park, Young Goo Shin, Won Sik Lee
J Korean Endocr Soc. 1995;10(4):424-427.   Published online November 7, 2019
  • 1,242 View
  • 24 Download
AbstractAbstract PDF
Periodic paralysis associated with thyrotoxicosis is characterized by intermittent flaccid paralysis of the skeletal muscle. The paralysis usually involve the skeletal muscle of the limbs, especially lower extrimities. In general, sensory function is intact. Involvement of respiratory, ocular or bulbar muscles is very rare, but bulbar and respiratoy invelvement may prove fatal. It is very rare a case that has severe clinical manifestation such as cardiac arrest. We report a case of thyrotoxic hypokalemic periodic paralysis presenting as cardiac arrest.
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Original Article
Clinical Study
Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease
Suyeon Park, Tae Yong Kim, Soyoung Sim, Seonhee Lim, Mijin Kim, Hyemi Kwon, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
Endocrinol Metab. 2016;31(1):142-146.   Published online March 16, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.1.142
  • 4,431 View
  • 40 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   
Background

Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis characterized by acute attacks of muscle weakness and hypokalemia. Recently, variation in several genes was suggested to be associated with TPP. This study evaluated the genetic predisposition to TPP in terms of the β2-adrenergic receptor (ADRB2), androgen receptor (AR), and γ-aminobutyric acid receptor α3 subunit (GABRA3) genes.

Methods

This study enrolled 48 men with Graves disease (GD) and TPP, and 48 GD patients without TPP. We compared the frequencies of candidate polymorphisms between the two groups.

Results

The frequency of the Gly16/Gly16 genotype in ADRB2 was not significantly associated with TPP (P=0.32). More CAG repeats (≥26) in the AR gene were not correlated with TPP (odds ratio [OR], 2.46; 95% confidence interval [CI], 0.81 to 8.09; P=0.08). The allele frequency of the TT genotype in the GABRA3 gene was not associated with TPP (OR, 1.83; 95% CI, 0.54 to 6.74; P=0.41).

Conclusion

The polymorphisms in the ADRB2, AR, and GABRA3 genes could not explain the genetic susceptibility to TPP in Korean men with GD.

Citations

Citations to this article as recorded by  
  • RNASET2,GPR174, and PTPN22 gene polymorphisms are related to the risk of liver damage associated with the hyperthyroidism in patients with Graves’ disease
    Qing Zhang, Shaozheng Liu, Yanxing Guan, Qingjie Chen, Qing Zhang, Xiang Min
    Journal of Clinical Laboratory Analysis.2018;[Epub]     CrossRef
  • Articles inEndocrinology and Metabolismin 2016
    Won-Young Lee
    Endocrinology and Metabolism.2017; 32(1): 62.     CrossRef
  • Periodic Paralysis and Encephalopathy as Initial Manifestations of Graves’ Disease
    Theocharis Tsironis, Athanasios Tychalas, Dimitrios Kiourtidis, Jannis Kountouras, Georgia Xiromerisiou, Jobst Rudolf, Georgia Deretzi
    The Neurologist.2017; 22(4): 134.     CrossRef
  • Thyrotoxic periodic paralysis
    Zdeněk Doležel, Dana Novotná, Helena Schneiderová, Jan Papež, Martin Jouza
    Pediatrie pro praxi.2016; 17(6): 379.     CrossRef
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Case Reports
Thyrotoxic Periodic Paralysis Induced by Dexamethasone.
Eun Ju Lee, Tae Kyoon Kim, Min Jeong Kwon, Soon Hee Lee, Jeong Hyun Park
Endocrinol Metab. 2012;27(4):299-302.   Published online December 20, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.4.299
  • 66,595 View
  • 28 Download
  • 2 Crossref
AbstractAbstract PDF
Thyrotoxic periodic paralysis (TPP) is a disease characterized by sudden onset and muscle paralysis. It occurs in the setting of hypokalemia of thyrotoxicosis. Cases of TPP induced by a glucocorticoid such as prednisolone or methylprednisolone have been reported. We report on two patients, each of whom received a dexamethasone injection and subsequently developed TPP. Both patients experienced sudden, flaccid paralysis of both extremities after the injection but recovered completely after receiving a potassium replacement. Laboratory results revealed thyrotoxicosis. The patients were diagnosed with Graves' disease and discharged after receiving treatment with methimazole and propranolol. This report provides the clinical description of TPP induced by dexamethasone injection. These cases suggest that clinicians must consider the presence of hyperthyroid disease in patients who develop acute paralysis after treatment with a glucocorticoid, even in the absence thyrotoxic symptoms. Furthermore, physicians should be aware that TPP can occur even in response to dexamethasone used for treatment of thyrotoxic crisis or Graves' ophthalmopathy.

Citations

Citations to this article as recorded by  
  • Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review
    Keivan Sahebi, Hassan Foroozand, Mohammad Bahmei, Raziee Taghizadeh, Samane Zare, Soroor Inaloo
    Heliyon.2025; 11(2): e41675.     CrossRef
  • Glucocorticoid-Induced Hypokalemic Periodic Paralysis after Short-Term Use of Tenofovir with Hypophosphatemia: A Case Report
    Yujin Shin, Yonglee Kim, Kyong Young Kim, Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Min Young Kim, Jaehoon Jung, Hosu Kim
    Medicina.2021; 58(1): 52.     CrossRef
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A Case of Thyrotoxic Periodic Paralysis with Rhabdomyolysis.
Seo Hee Lee, Seong Yeol Kim, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Seong Jin Lee, Eun Gyoung Hong, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo
J Korean Endocr Soc. 2008;23(6):425-429.   Published online December 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.6.425
  • 2,123 View
  • 25 Download
AbstractAbstract PDF
Hyperthyroidism combined with rhabdomyolysis is extremely rare. There are only 6 reported cases of hyperthyroidism accompanied with rhabdomyolysis in the medical literature. Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and intracellular protein to leak into the circulation. The causes of rhabdomyolysis include trauma, electrolyte abnormality, infection, drug, toxin and hypothyroidism. We report here on a patient who presented with thyrotoxic periodic paralysis and rhabdomyolysis with hypokalemia. He complained of lower leg paralysis along with muscle tenderness, and the laboratory findings showed elevated creatine kinase (CK) levels. After treatment by hydration, potassium replacement and drug medication, including propylthiouracil and beta-blocker, his CK levels were normalized and his symptoms were much improved. For patient with thyrotoxic periodic paralysis and muscle tenderness, the possibility of rhabdomyolysis should be clarified by examining the CK levels.
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Original Article
CAG Repeats in the Androgen Receptor Polymorphism do not Correlate with Thyrotoxic Periodic Paralysis.
Won Gu Kim, Tae Yong Kim, Jung Min Kim, Yoon Soo Rhee, Hyun Jeung Choi, Won Bae Kim, Young Kee Shong
J Korean Endocr Soc. 2008;23(2):117-122.   Published online April 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.2.117
  • 2,171 View
  • 21 Download
  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
Thyrotoxic periodic paralysis (TPP) occurs mostly in males, but no studies have addressed the role of androgen in the disease. Hyperinsulinemia can precipitate acute paralysis in TPP patients. CAG repeats in the androgen receptor (AR), an X-linked gene, correlate with serum insulin levels. AIM: To evaluate whether CAG repeats in the AR gene might predict the susceptibility to TPP in Korean male Graves' patients. METHODS: We evaluated CAG repeat length in a series of 33 male TPP patients and 48 control patients by direct sequencing of the PCR product of the AR promoter site. Control patients were male Graves' patients without a history of paralysis. RESULTS: The CAG repeat length varied from 15 to 34 (median of 23). The upper quartile of CAG length was equal to or above 26 repeats (long AR). The distribution of long AR was 0.30 in TPP and 0.15 in control patients, respectively (odds ratio, 2.51; 95% confidence interval, 0.92~6.85; P = 0.09). CONCLUSION: AR gene polymorphisms may not confer genetic susceptibility to TPP in Korean male patients with Graves' disease.

Citations

Citations to this article as recorded by  
  • Contributions of CAG repeat length in the androgen receptor gene and androgen profiles to premature pubarche in Korean girls
    Min Jae Kang, Jeong Seon Lee, Hwa Young Kim, Hae Woon Jung, Young Ah Lee, Sun Hee Lee, Ji-Young Seo, Jae Hyun Kim, Hye Rim Chung, Se Young Kim, Choong Ho Shin, Sei Won Yang
    Endocrine Journal.2017; 64(1): 91.     CrossRef
  • Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease
    Suyeon Park, Tae Yong Kim, Soyoung Sim, Seonhee Lim, Mijin Kim, Hyemi Kwon, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
    Endocrinology and Metabolism.2016; 31(1): 142.     CrossRef
  • Androgen Receptor Gene CAG Repeat Polymorphism and Effect of Testosterone Therapy in Hypogonadal Men in Korea
    Min Joo Kim, Jin Taek Kim, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
    Endocrinology and Metabolism.2011; 26(3): 225.     CrossRef
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Case Reports
A Case of Licorice Induced Hypokalemic Paralysis with Rhabdomyolysis.
Hyun Il Hong, Koon Hee Han, Jung Won Hwang, Young Don Kim, Myung Sook Shim, Jin Yub Kim
J Korean Endocr Soc. 2005;20(2):179-182.   Published online April 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.2.179
  • 2,217 View
  • 20 Download
  • 4 Crossref
AbstractAbstract PDF
Prolonged ingestion of licorice can cause hypermineralocorticoidism, with sodium retention, potassium loss and hypertension. Nevertheless, its initial presentation with a very severe degree of hypokalemic paralysis and rhabdomyolysis are exceedingly rare. We describe a patient who experienced hypokalemic paralysis and rhabdomyolysis after licorice ingestion. The patient's initial blood pressure was 160/80mmHg. The major biochemical abnormalities included; hypokalemia(K+ 1.3mEq/L), metabolic alkalosis, with a pH of 7.64, and urine myoglobin > 3000ng/mL. The plasma rennin activity and aldosterone level were suppressed. The 24 hour urine cortisol concentration was normal. The patients, over a 1 month period, had ingested 500g of licorice boiled in water. After quitting the licorice, the hypokalemia and muscle paralysis gradually improved and blood pressure returned to normal

Citations

Citations to this article as recorded by  
  • A case of chronic licorice intoxication-induced apparent mineralocorticoid excess syndrome
    Young Jae Lim, Ji Eun Kim
    Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 151.     CrossRef
  • Hypokalemic Periodic Paralysis Developed in a Patient with Neurogenic Diabetes Insipidus
    Jihyeon Hwang, Joo Hye Sung, Ye Eun Kim, Keonyeup Kim, Seong-Hwan Kim, Young Bin Park, Seol-Hee Baek
    Journal of the Korean Neurological Association.2021; 39(3): 177.     CrossRef
  • Electrical storm induced by hypokalemia associated with herbal medicines containing licorice
    Hyun Kuk Kim, Sung Soo Kim
    Translational and Clinical Pharmacology.2019; 27(2): 69.     CrossRef
  • Influence of Herbal Complexes Containing Licorice on Potassium Levels: A Retrospective Study
    WooSang Jung, SeungWon Kwon, JinWook Im, SeongUk Park, SangKwan Moon, JungMi Park, ChangNam Ko, KiHo Cho, Paul Posadzki
    Evidence-Based Complementary and Alternative Medicine.2014;[Epub]     CrossRef
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A Case of Thyrotoxic Periodic Paralysis Presenting as Ventricular Tachycardia.
Woun Seok Ryu, Sang Mi Lee, Sung Jun Sim, Dong Wook Lee, Jong Dae Han, Eun A Chung, In Kwan Song, Hwan Won Choi, Dong Youb Cha, Ie Byung Park
J Korean Endocr Soc. 1999;14(3):587-591.   Published online January 1, 2001
  • 1,182 View
  • 20 Download
AbstractAbstract PDF
sociated with hyperthyroidism occurs in 2.0% of Graves disease and is characterized by myasthenia or bilateral flaccid paralysis of lower extremity, in some cases, it may be accompanied with cardiac arrhythmias which are mostly due to hypokalemia. The most common type of cardiac arrhythmias associated with hyperthyroidism is sinus tachycardia, 1015% of patients have atrial fibrillation. Rarely, ventricular tachycardia or ventricular fibrillation develop and lead to cardiac arrest in severe case. A 26-year-old man was admitted to the hospital because of weakness of lower extremity. The initial EKG showed ventricular tachycardia. The laboratory results were, TSH 0.08 microunit/mL, free T4 4.11 ng/mL, T3 2.88 ng/mL, serum K 1.9 mEq/L. He was diagnosed as ventricular tachycardia associated with hypokalemic thyrotoxic periodic paralysis. His symptoms improved during the treatment with propylthiouracil and potassium replacement. We report a case of thyrotoxic periodic paralysis presenting as ventricular tachycardia with brief review of literatures.
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A Case of Aldosteronoma Complicated with Hyperthyroidism.
Yeo Joo Kim, Mi Rim Kim, Moon Seok Nam, Hyo Young Min, Sung Ryol Kwon, Sung Wook Cho, Young Ub Cho, Yong Sung Kim
J Korean Endocr Soc. 1998;13(3):480-488.   Published online January 1, 2001
  • 1,254 View
  • 19 Download
AbstractAbstract PDF
Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.
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