Epilepsy secondary to intracranial calcification cause by hypothyroidism and chronic hypocalcaemia: a case report

Intracranial calcification is a rare complication of endocrine disorders, such as hypothyroidism. We present a case of a 37-year-old woman who had recurrent generalized tonic-clonic seizures since the age of 19 that were unresponsive to antiepileptic medications. Upon examination, cerebellar ataxia was observed. A brain CT scan and laboratory investigations conducted in April 2023 revealed extensive bilateral symmetric cerebral and cerebellar calcifications, hypothyroidism, hypocalcemia, hypophosphatemia, vitamin D deficiency, and normal levels of parathyroid hormone and kidney, and liver function tests. Antithyroid peroxidase antibodies were negative. The patient's brain calcifications, epilepsy, and ataxia were attributed to chronic hypocalcemia secondary to hypothyroidism and vitamin D deficiency. Treatment included levothyroxine, calcium, vitamin D supplements, and antiepileptic drugs (oxcarbazepine and levetiracetam). Over a year of follow-up, significant medical and neurological improvements were noted, with normalization of thyroid function tests and well-controlled seizures on medication. In conclusion, extensive intracranial calcification and recurrent seizures are uncommon complications of hypothyroidism, likely due to chronic hypocalcemia and hypovitaminosis D. Management involved long-term therapy with levothyroxine, calcium, vitamin D supplements, and antiepileptic drugs.