Spontaneous intracranial hypotension in Graves’ disease

Autoimmune thyroid disorders such as hyperthyroidism and hypothyroidism are rare causes of intracranial pressure alterations. We present a case of spontaneous intracranial hypotension associated with Graves’ disease which was not reported previously in the literature. A 42-year-old woman was admitted to our institution because of a sudden developed headache, neck pain, nausea and vomiting. The headache was severe during standing and walking but improved within 15 to 30 minutes after lying down. Thyroid gland was grade 1b diffuse palpable and other physical examinations were normal. Autoimmune hyperthyroidism was diagnosed according to laboratory results. Gadolinium-enhanced magnetic resonance imaging revealed a hyperintensity that is consistent with thickened dura and subdural effusion. The patient was managed with bed rest, hydration, methimazole, methyl-prednisolone 16 mg/day of three days and then tapered gradually. After these medications the headache resolved. It should be kept in mind that encephalopathy associated autoimmune thyroid disease may be related with spontaneous intracranial hypotension.