Abstracts

Rationale: Reporting a case of acute symptomatic seizure secondary to thyrotoxicosis, for its extreme rarity and potential curability. English medical literature search showed around 15 adult case reports only, the majority highlighting the reversibility of epileptogenicity with anti-thyroid and temporary anti-seizure medications (ASM).

The neurological manifestations of thyrotoxicosis include restlessness, delirium, somnolence, convulsions, and coma. Seizures due to thyrotoxicosis are very rare with an incidence of 0.2% to 1.2% of all thyrotoxic cases. They can be focal, generalized, or status epilepticus. Thyroid storm, the extreme manifestation of thyrotoxicosis, is very rare (0.57 to 0.76 cases per 100,000 per year in the general population).

Methods: Brought to the emergency room, a 30-year-old man with tobacco/marijuana use disorder, having palpitations for 3 months, abdominal pain, loss of appetite, vomiting, diarrhea, and fatigue for 1 week. No other significant past or family history. Heart rate 130/min. BP 124/81 mmHg. Respiratory rate 16/min. Diffuse thyromegaly. Proptosis present. S1 loud, S2 normal. Chest clear. Abdomen - tender epigastrium. Troponon x 2 - negative. EKG - AV nodal reentrant tachycardia, no ischemic changes. Free T4 - 7.77 (0.9 - 1.9 ng/dl), TSH - < 0.010 (0.27 - 4.2 ulU/ml). Burch - Wartofsky Scale - 35 (impending thyroidstorm). Pro BNP - 5117 (1-125 pg/ml). Diagnosed as thyrotoxicosis with heart failure (ejection fraction 20%). Started on Propylthiouracil, Propranolol, and Hydrocortisone along with anti-failure measures. While awaiting transfer to the ward, developed generalized tonic-clonic seizures with respiratory distress requiring intubation. Subsequently had a cardiac arrest (pulseless electrical activity), revived appropriately. MRI brain was normal and EEG showed diffuse slowing.