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

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

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。

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.