Hoffmann’s Syndrome a Presenting Manifestation of Hypothyroidism

Mohammed Nasir Uddin^1, , Abbas Uddin², Mohammed Abbas Uddin Chy³ and Taslima Khan⁴

¹Department of Medicine, BGC Trust Medical College

²Department of ENT & Head neck Surgery, BGC Trust Medical College

³Department of Radiology & Imaging, BGC Trust Medical College

⁴Clinical Sonologist & General Physician

Cite this paper

Mohammed Nasir Uddin, Abbas Uddin, Mohammed Abbas Uddin Chy and Taslima Khan. Hoffmann’s Syndrome a Presenting Manifestation of Hypothyroidism. American Journal of Medical Case Reports. 2014; 2(4):75-77. doi: 10.12691/AJMCR-2-4-1

Abstract

Hypothyroidism is one of the most prevalent endocrine disorders. Different neuromuscular complications can develop with hypothyroidism. Nonspecific neuromuscular complaints like myalgia, muscle cramps and mild elevation of Creatine Kinase (CK) are the most common myopathic features related to hypothyroidism. Other myopathic features included proximal muscle weakness and myxoedema. The neurological manifestations of hypothyroidism are very unusual to see as initial symptoms and they usually occur late in the course of disease. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. The electrophysiological study may reveal features suggestive of myopathy, neuropathy or mixed pattern. The symptoms and also the serum levels of enzymes return to normal with hormone replacement therapy. We report a case of hypothyroidism with calf muscle hypertrophy and proximal myopathy as the initial symptoms.

Keywords

hypothyroidism, pseudo hypertrophy, Hoffmann’s syndrome

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Mastaglia FL, Ojeda VJ, Sarnat HB, Kakulas BA. Myopathies associated with hypothyroidism: a review based upon 13 cases. Inter Med J 1988; 86: 799-806.
[2]	Lin RT, Liu CK, Tai CT, Lai CL. Hypothyroid myopathy pathological and ultrastructural study. Kaohsiung J MedSci2000; 16:68-75.
[3]	Scott KR, Simmons Z, Boyer PJ. Hypothyroid myopathy with a strikingly elevated serum creatine kinase level. Muscle and Nerve 2002; 26: 141-44.
[4]	Udayakumar N, Rameshkumar AC, Srinivasan AV. Hoffmann syndrome: Presentation in hypothyroidism. JPostgrad Med 2005; 51: 332-33.
[5]	Qureshi W, Hassan G, Khan GQ, et al. Hoffmann's syndrome: a case report. Ger Med Sci, 2005; 3: 05.
[6]	Ghervan C, Tibre V, Prisca C, Duncea I. Muscular pseudohypertrophy associated with Hashimotoæs thyroiditis (Hoffmann syndrome) - First familial case report.ActaEndocrinologica2009; 5(1): 107-16.
[7]	Chopra BK, Singh G, Puri A. Hoffman's Syndrome(hypothyroid Myopathy). J Assoc Physicians India 1972; 20: 387-90
[8]	Pareyson D, Morandi L, Scaioli V, et al. Sghirlanzoni.Neurogenic muscle hypertrophy. J Neurology 2008; 236: 292-95.
[9]	Kaux JF, Castermans C, Delmotte P, Bex M. Hoffmannsyndrome presenting to the emergency department. AnnReadapt Med Phys 2007; 50: 310-12.
[10]	Vasconcellos LFR, Peixoto MC, Oliveira TN, Penque G,Leite A, Claudia C. Hoffman's syndrome: pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report. ArqNeuro-Psiquiatr 2003; 61(3B): 851-54.