high concentrations of factor viii and von willebrand factor ( vwf ) contribute to a hypercoagulable state in hyperthyroidism .
lower vwf concentrations in hypothyroidism may protect against venous thrombosis .. studies have suggested hypercoagulable state in hypothyroidism .
45-year - old female presented in emergency with complaints of headache since 1 month , vomiting since 1 day , and weakness with numbness and tingling in right half of body since 12 h. her weakness progressed to quadriparesis overnight .
on examination she was drowsy and disoriented . on neurological examination , reflexes were present and muscle tone was normal but power was 1/5 on right side and 3/5 in left half of body .
thyroid function tests were suggestive of subclinical hypothroidism t3 - 0.94 ng / ml , t4 - 8.36 g / dl , tsh - 13.92 miu / ml .
thrombophilia profile including prothrombin time index / international normalized ratio , serum homocysteine ( 5.6 mol / l ) , ana , lupus anticoagulant , igm and igg cardiolipin antibodies , and apla antibodies were negative .
mri brain showed loss of flow void of superior sagittal and left transverse sinuses with altered signal appearing hyperintense on t1w and fluid - attenuated inversion recovery ( flair ) images suggesting thrombosis .
she was put on heparin and warfarin . her headache improved after 4 days of treatment and patient was discharged after 7 days with no residual neurological deficit .
hypothyroidism favors a procoagulant by decreasing fibrinolysis ( high levels of alfa2-antiplasmin and plasminogen activator inhibitor-1 ) , inducing hyperhomocysteinemia , and high c - reactive protein ( crp ) .
decreased fibrinolytic capacity , high crp levels , and coagulation factors abnormalities can occur even in subclinical hypothyroidism .
elevated plasma thrombin - activatable fibrinolysis inhibitor levels were observed in patients with mild and overt hypothyroidism , and levothyroxine treatment was effective in reducing these levels .
chronic low - grade inflammation and impaired nitric oxide availability in the endothelium have been demonstrated in hypothyroidsm .
this case emphasizes the need for thyroid evaluation in all patients with cvt and other venous thromboembolic event even in the absence of clinical signs of hypothyroidism .
 cerebral venous thrombosis ( cvt ) is a multifactorial condition which is described as idiopathic in 12.5% of patients . 
 hyperthyroidism has been associated with cvt in many case reports , and increased levels of factor viii and von willebrand factor ( vwf ) have been proposed as the possible link in this association , but only few rare case reports have described an association of hypothyroidism with cvt . 
 we report here a case of autoimmune thyroiditis presenting with cvt . 
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