Severe Post-partum Hypothyroidism Triggering Psychogenic Non-epileptiform Seizures, Myopathy, and Myxedema Coma 2024 Welborn and Zwain

[Andy]

Abstract

This study details the development of severe post-partum hypothyroidism exacerbating psychogenic non-epileptiform seizures (PNES) and culminating in myxedema coma. A 29-year-old female with a history of anxiety, attention-deficit/hyperactivity disorder (ADHD), and post-partum depression presented with confusion, aphasia, and severe bilateral leg cramping five months following vaginal delivery.

Initial laboratory tests indicated elevated creatine kinase (CK) levels, suggestive of non-traumatic rhabdomyolysis. Subsequent seizure-like episodes and the absence of epileptiform activity on the electroencephalogram (EEG) raised suspicions of PNES. Further investigation upon readmittance to the hospital revealed a thyroid-stimulating hormone (TSH) level of 216 mIU/L (range: 0.4-4.0 mIU/L), free thyroxine (T4) level of 0.2 ng/dL (range: 0.8-1.8 ng/dL), and a CK level of 2083 U/L (range in females: 30-150 U/L), indicating severe hypothyroidism with myopathy. Reintroducing levothyroxine (Synthroid), which was previously discontinued during pregnancy, rapidly resolved her symptoms, supporting suspicions that her non-epileptic seizures and myopathy were both caused by her underlying severe post-partum hypothyroidism. She was maintained on levothyroxine with only one seizure-like episode following hospital discharge.

This case illustrates the importance of a thorough endocrine assessment in patients with neuropsychiatric presentations, particularly in the peripartum period. It highlights the potential for severe thyroid dysfunction to manifest as PNES, emphasizing the complexity of diagnosing and managing such cases. The findings advocate for a multidisciplinary approach to evaluating post-partum females with neurological and psychiatric symptoms and provide evidence for the link between thyroid disorders and PNES, advocating for a nuanced approach in similar clinical scenarios.

Open access, https://www.cureus.com/articles/245...tiform-seizures-myopathy-and-myxedema-coma#!/

 

[Andy]

The title is crap - non-epileptiform seizures triggered by "severe post-partum hypothyroidism" that responded to treatment for that hypothyroidism seem to be most definitely not psychogenic.

 

[SNT Gatchaman]

non-epileptiform seizures triggered by "severe post-partum hypothyroidism" that responded to treatment for that hypothyroidism seem to be most definitely not psychogenic.

Well. According to Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research (2021, The Journal of Neuropsychiatry and Clinical Neurosciences) —

Psychogenic nonepileptic seizures (PNES) are the most common subtype of functional neurological disorder (FND; conversion disorder). They consist of paroxysmal alterations in motor, sensory, autonomic, or cognitive functions that are not associated with ictal epileptiform activity. Instead, PNES are neuropsychiatric symptoms thought to occur in the context of a complex array of biological and psychosocial vulnerabilities.

The biopsychosocial formulation states that an accumulation of individual predisposing, precipitating, and perpetuating factors leads to PNES. These factors are involved in the development of a reflexive way of maladaptive coping occurring in the context of past traumatic experiences, current life challenges, and physical health issues. Cultural influences and stressors also affect presentations of PNES.

So you see, it wasn't the profound hypothyroidism that caused the non-epileptiform seizures, it was the maladaptive coping with the profound hypothyroidism. It's an easy mistake to make, but just remember, the biopsychosocial formulation is never wrong.

( /sarcasm, in case anyone is reading this from the future.)

 

[rvallee]

Well. According to Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research (2021, The Journal of Neuropsychiatry and Clinical Neurosciences) —





So you see, it wasn't the profound hypothyroidism that caused the non-epileptiform seizures, it was the maladaptive coping with the profound hypothyroidism. It's an easy mistake to make, but just remember, the biopsychosocial formulation is never wrong.

( /sarcasm, in case anyone is reading this from the future.)

This crap is making me reevaluate everything I thought about religions and cults.

And it's so weird seeing this old pre-science style of rhetoric, around some "the formulation states" and a bunch of meaningless waffle that is pure opinion and belief, mixed with what is supposed to be a serious science-based profession. It all might as well be some church edict for all that it's valid, but it's presented like it's legitimate. Incredible.