Date Published: September 9, 2008
Publisher: Public Library of Science
Author(s): Ronald C. W Ma, Howan Leung, Patrick Kwan, Wing Yee So, Florence Yap, Chun Chung Chow
Abstract: Ronald Ma and colleagues discuss the differential diagnosis, investigation, and management of this patient.
Partial Text: 50-year-old woman presented in May 2006 with recurrent generalised convulsions. She had a history of hypertension treated with indapamide, but was otherwise well. Her older sister and mother were known to have thyroid disease. She did not have any history of chronic alcohol use nor any recent history of head injury. The patient had never lived outside of Hong Kong. Prior to admission, she was taken to her general practitioner by her family for gradual onset of decreased alertness, cognitive decline, and reduced verbal communication, which worsened over the course of one week. She was found to have hypothyroidism with TSH (thyroid stimulating hormone) 52.3 mIU/l (normal range 0.47–4.68 mIU/l) and free T4 4.2 pmol/l (normal range 10.0–28.2 pmol/l), and was started on thyroxine replacement. Four days later, she developed two generalised seizures within three days and was admitted into hospital. She was afebrile and had no focal neurological signs on examination. Baseline investigations, including electrolytes, liver function tests, calcium, and phosphate, were normal. Random plasma glucose was 5.7 mmol/l. Magnetic resonance imaging (MRI) of brain was unremarkable. She was subsequently transferred to our hospital for further management.