Myxedema, papilledema, and elevated CSF protein

Elevated CSF protein has been well documented in patients with isolated clinical hypothyroidism and autoimmune thyroiditis-associated encephalopathy.1–5⇓⇓⇓⇓ Researchers postulate this is caused by dysfunction of the blood-brain barrier (BBB) and protein exchange.1,4⇓ We report a patient with severe hypothyroidism associated with papilledema, elevated CSF protein, and elevated intracranial pressure (ICP). Her symptoms and signs improved with treatment of hypothyroidism. A 45-year-old woman sought treatment for a 2-year history of progressive bilateral blurred vision. Vision did not correct with glasses but did not interfere with activity. Other history included an intermittent dull bilateral frontal headache, low energy, and irregular menses. Her family reported she slept nearly the entire day and was less active. She completed 3 months of acetazolamide therapy for presumed pseudotumor cerebri without improvement in her vision or headache. Her only medical history was pernicious anemia treated with monthly B12 supplementation. Examination revealed a female with a …