Severe Hypothyroidism Presenting Acute Conscious Change and Seizures: A Case Report

重度甲狀腺功能低下以急性意識改變與癲癇發作表現－病例報告

李瑞祥(Jui-Hsiang Li) ； 陳又誠(Yu-Cheng Chen) ； 羅世慧(Su-Huey Lo)

《醫學與健康期刊》 8卷2期 (2019/09) Pp. 111-116

摘要

Seizures have rarely been reported in patients with hypothyroidism. Herein, we report case involving a 38-year-old female who was admitted to our emergency ward due to acute conscious change with fever and seizures. Brain MRI showed post-ictal right hemispheric brain swelling with midline shift to the left. An endocrine function test showed TSH 214μIU/ml, free T4 0.23ng/dl, and normal adrenal function. Impending myxedema crisis was impressed. After receiving treatment with Eltroxine and Solu-Cortef, the seizures and conscious change improved. Myxedema crisis has been reported to manifest in a number of unusual and dangerous forms. Clinicians should keep this disease in mind when treating patients with hypothyroidism.

關鍵字

Hypothyroidism ； Thyroid hormone ； Seizure ； Myxedema crisis

並列摘要

以癲癇為表現的甲狀腺低能症病患，很少在文獻中提及。一位38歲女性因發燒、急性意識改變並有癲癇發作被送至本院急診。磁振造影結果顯示癲癇後腦半球腫脹，並中線向左側偏移。內分泌功能檢查顯示TSH=214μIU/ml, free T4=0.23ng/dL，確診為重度甲狀腺功能低下。在補充solucortef和eltroxine後，病患意識狀態恢復正常，癲癇也不再發作了。黏液水腫性急症，可以有很多危險且不常見的表現，臨床醫師應該對這疾病謹記在心。

並列關鍵字

甲狀腺功能低下 ； 甲狀腺賀爾蒙 ； 癲癇 ； 黏液水腫性急症

參考文獻

Evans EC: Neurological complications of myxedema: convulsions. Annuals of internal Medicine 1960;52:434-44.

Tamijani SM, Karimi B, Amini E, Golpich M, Dargahi L, Ali RA: Thyroid hormones: possible roles in epilepsy pathology. Seizure. 2015;31:155-64.

Woods KL, Holmes GK: Myxoedema coma presenting in status epilepticus. Postgrad Med J 1977;53:46-8.

Jansen HJ, Doebé SRO, Louwerse ES, et al.: Status epilepticus caused by a myxoedema coma. Neth J Med 2006;64:202-5.

Fjølner J, Søndergaard E, Kampmann U, Nielsen S: Complete recovery after severe myxoedema coma complicated by status epilepticus. BMJ Case Rep 2015;2015. pii: bcr2014209071.