Estatus convulsivo superrefractario desencadenado por tormenta tiroidea. Presentación de caso clínico

Thyroid storm is one of the most critical situations among endocrine emergencies, with low incidence (10% of hospitalized patients with thyrotoxicosis) and significant mortality ranging from 20% to 30%. The most common etiology is Graves' disease and the main triggering factor is infection. Frequent neurological symptoms in hyperthyroidism include: tremor, nervousness and emotional lability, although seizures are exceptional. Of all the patients mentioned in literature who presented seizures as a result of thyrotoxicosis, only four cases were in the form of status epilepticus. Although the physiopathogenic mechanism by which hyperthyroidism causes seizures is not clear yet, it is suspected that the increase of thyroid hormones influences on NA + K + ATPase-pump activity, thus resulting in high concentrations of intraneuronal sodium. The reversibility of the phenomenon suggests that neural changes are functional in nature as opposed to structural brain damage. Consequently, in many cases, antiepileptic drugs are only necessary at the onset of the disease, since seizures self-reduce when the patient recovers the euthyroid state. In the case of the patient presented here, the super-refractory status was lethal. We attribute the lack of response to treatment to the confluence of several factors, such as: intercurrent infection, history of brain damage due to multiple drug addiction and the presence of an immune-mediated phenomenon, taking into account patient's history of Graves' disease and high levels of antithyroid antibodies.