A case of Moyamoya disease with Graves’ disease presenting clinical and radiological improvement only after treatment for hyperthyroidism

Abstract

Graves’ disease, an autoimmune thyroid disease that results in hyperthyroidism, is rarely complicated by progressive stenosis or the occlusion of proximal intracranial arteries. The combination of these two pathologies was classically categorized as “quasi-Moyamoya disease”, but the revised diagnostic criteria for Moyamoya disease established a new disease concept of “Moyamoya disease with Graves’ disease”, for which an appropriate treatment is still unclear. In the present case, a 35-year-old woman showed transient hemiparesis and poor concentration. After serum analysis and brain imaging, she was diagnosed as having Moyamoya disease with Graves’ disease. Her symptoms and radiological findings improved dramatically after medical treatment for Graves’ disease without any other interventions. The present case represents a valuable reference for selecting treatment steps for this rare disease with a unique pathophysiology.