Status Epilepticus as a Life-Threatening Manifestation of Myxedema Crisis

Myxedema coma is a rare life-threatening emergency that usually presents in the elderly during the winter months. The neurological changes caused by uncontrolled hypothyroidism may precipitate seizure activity and its deleterious consequences. A 65-year-old homeless man with a history of non-Hodgkin lymphoma in remission for over 20 years presented to the emergency department (ED) following an episode of syncope. His physical examination was remarkable for hypothermia and bradycardia. Shortly after the admission, he had two tonic-clonic seizures with sphincter relaxation and no recovery between the convulsions. His thyroid-stimulating hormone (TSH) level was 304 uIU/ml. He received appropriate treatment for his condition and was discharged after a full recovery. This case illustrates the catastrophic consequences of long-term uncontrolled hypothyroidism. A high index of clinical suspicion is essential for beginning prompt hormone supplementation in such patients.