To describe the difference between syncope and epileptic seizures is tricky, especially when patients have convulsive movements. Doctors sometimes get it wrong, which means people end up taking seizure medications they don’t need while the real issue goes untreated. Every so often, an underlying problem like hypothyroidism triggers trouble with the autonomic nervous system and leads to syncope.
Case Presentation: We saw a patient would have epilepsy, but it turned out she was having vasovagal-type syncope related to her untreated hypothyroidism. What helped us figure it out? We used video-EEG, ECG, tilt table tests, and checked her thyroid. This made the real diagnosis clear and shaped her treatment plan.
Discussion: To discuss why this happens! Reflex syncope comes down to sudden changes in the autonomic nervous system that drop blood pressure and slowdown the heart rate. Sometimes, these episodes look a lot like seizures because of the muscle jerks or stiffening. New research (from 2020 to 2025) shows thyroid problems especially hypothyroidism throw off the body’s autonomic balance, making vasovagal syncope more likely to happen. To investigate syncope apart from epilepsy, we need to dig into the patient’s history, run EEG and ECG at the same time, and do autonomic function tests. We’ve included diagnostic flowcharts and helpful figures.
Conclusion: When someone has unusual seizures or doesn’t respond to seizure meds, doctors need to think about syncope mimics especially if there’s a thyroid issue. Thyroid dysfunction can push people toward reflex syncope, so a step-by-step approach (history, tilt table, EEG/ECG together) is key.