title: Thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan. nishityo@fmu.ac.jp.
authors: Akira
authors: A
authors: Wada
authors: Yoshiaki
authors: Y
authors: Suzuki
authors: Sanae
authors: S
authors: Midorikawa
authors: Satoshi
authors: S
authors: Takeuchi
authors: Yasuto
authors: Y
authors: Kunii
authors: Hirooki
authors: H
authors: Yabe
authors: Shin-Ichi
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authors: Niwa