Wada Akira, Suzuki Yoshiaki, Midorikawa Sanae, Takeuchi Satoshi, Kunii Yasuto, Yabe Hirooki, Niwa Shin-Ichi
Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan.
J Med Case Rep. 2011 Sep 5;5:432. doi: 10.1186/1752-1947-5-432.
Non-convulsive status epilepticus is a form of epileptic seizure that occurs without convulsions. Recent reviews suggest that the diagnosis of non-convulsive status epilepticus remains difficult. Here, we report the case of a patient with thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus.
Our patient was a 68-year-old Japanese woman. The results of endocrine testing after her first episode of non-convulsive status epilepticus suggested latent subclinical hypothyroidism: she had elevated thyroid-stimulating hormone with normal levels of free tri-iodothyronine and free thyroxine. On examination, a diagnosis of thyroid disorder was not supported by other test results and our patient remained untreated. A follow-up examination revealed that her thyroid-stimulating hormone levels had spontaneously normalized. When she consulted another doctor for confusion, the transient increase in thyroid-stimulating hormone levels following non-convulsive status epilepticus was mistaken for subclinical hypothyroidism, and unfortunately treated with levothyroxine. Our patient then experienced levothyroxine-induced non-convulsive status epilepticus.
In this report, we suggested possible mechanisms for latent hypothyroid-like hormone abnormality following epileptic seizures and the possibility of provoking epileptic seizures by administering levothyroxine for misdiagnosed subclinical hypothyroidism.
非惊厥性癫痫持续状态是一种不伴有惊厥发作的癫痫发作形式。近期综述表明，非惊厥性癫痫持续状态的诊断仍然困难。在此，我们报告一例非惊厥性癫痫持续状态后促甲状腺激素升高被误诊为亚临床甲状腺功能减退的病例。
我们的患者是一名68岁的日本女性。她首次出现非惊厥性癫痫持续状态后的内分泌检查结果提示潜在的亚临床甲状腺功能减退：促甲状腺激素升高，而游离三碘甲状腺原氨酸和游离甲状腺素水平正常。经检查，其他检查结果不支持甲状腺疾病的诊断，我们的患者未接受治疗。后续检查显示她的促甲状腺激素水平已自发恢复正常。当她因意识模糊咨询另一位医生时，非惊厥性癫痫持续状态后促甲状腺激素水平的短暂升高被误诊为亚临床甲状腺功能减退，不幸的是她接受了左甲状腺素治疗。随后我们的患者出现了左甲状腺素诱发的非惊厥性癫痫持续状态。
在本报告中，我们提出了癫痫发作后潜在的类似甲状腺功能减退激素异常的可能机制，以及因误诊的亚临床甲状腺功能减退给予左甲状腺素治疗而诱发癫痫发作的可能性。
