Thyroid function in pediatric acute encephalopathy: a case series of four children

Introduction Acute encephalopathy is associated with status epilepticus with fever and often leads to serious outcomes, while early diagnosis is difficult due to the primary symptoms being nonspecific. Transient thyroid hormone changes have been reported in pediatric patients with febrile seizures. However, the relationship between convulsion with fever and thyroid function remains unclear. Case presentation This study retrospectively analyzed thyroid function in 70 children hospitalized for convulsion with fever from 2018 to 2023, with a focus on four cases of pediatric acute encephalopathy. Thyroid hormone levels were predominantly within the laboratory reference ranges, except for one case with a mildly decreased thyroid-stimulating hormone level (0.32 μIU/mL; reference range, 0.43–4.83 μIU/mL) and one infant with a mildly elevated free triiodothyronine level (4.45 pg/mL; reference range, 2.39–3.86 pg/mL), the latter consistent with the physiologically higher free triiodothyronine concentrations of infancy. Three children demonstrated normal neurodevelopmental outcomes, whereas the child with trisomy 21 experienced severe developmental delay. Discussion The results of this study suggest that abnormal thyroid hormone levels are uncommon among pediatric patients with acute encephalopathy at the time of onset, indicating the limited diagnostic value of routine thyroid screening in pediatric acute encephalopathy. In addition, this study provides new insights into endocrine changes in children with acute encephalopathy, despite the negative findings and the few cases surveyed. Larger prospective studies with comprehensive assessments are needed to validate these results.