SummaryWe report the case of a 65-year-old woman with highly symptomatic orthostatic hypotension associated with primary hypothyroidism. This orthostatic hypotension was caused by an autonomic dysfunction with a loss of integrity of the baroreceptor reflex arc and proved to be quite reversible with thyroid hormone replacement. We are unaware of such a clinical feature of hypothyroid autonomic neuropathy and suggest that hypothyroidism should be considered as an additional cause of orthostatic hypotension.