A Rare Manifestation of Hypothyroid Myopathy: Hoffmann's Syndrome

Abstract

Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

“…Our patient most likely suffered from Hoffmann's syndrome, a rare condition characterized by increased muscular mass, muscle stiffness, proximal muscle weakness, and occasional muscle cramps in the presence of hypothyroidism [9]. Although muscle stiffness and weakness were less pronounced symptoms in the present case, a more focused clinical examination revealed proximal hypertrophy of the calves, upper arms, and shoulders in a patient who denied being physically active (Fig.…”

A Treatable Reason of Myopathy: Hypothyroidism

“…In our patient, muscle pain was also prominent (1). Although CK values are reported as 10 times higher than normal values, higher values reaching 29,000 U/L have also been reported (2,5). The effective treatment method is euthyroidism of the patient.…”

Hoffmann syndrome : about two new cases

“…Le syndrome de Hoffmann survient souvent chez des patients présentant une hypothyroïdie longtemps méconnue et sévère qui est, par ailleurs, peu symptomatique voire totalement asymptomatique 6 . Depuis la description originale de ce syndrome, le diagnostic de l'hypothyroïdie a été rendu plus facile avec le dosage des hormones thyroïdiennes.…”

“…Sur le plan thérapeutique, la substitution hormonale permet, en général, une évolution lente surtout sur le plan biologique 3,6 . Nos 2 patients ont rapidement évolué de façon favorable aussi bien sur le plan clinique que biologique.…”

“…Le syndrome de Hoffmann est une myopathie hypertrophique se manifestant par une augmentation de la masse musculaire, une raideur et une fatigue musculaire proximale 5 . Cette forme, du fait de sa rareté, reste méconnue et de diagnostic difficile, pouvant conduire le médecin à multiplier les examens complémentaires devant le trouble musculaire, alors qu'un simple dosage des hormones thyroïdiennes permet de poser le diagnostic 6 . Il semble important de connaître ce diagnostic afin de l'évoquer devant son tableau clinique.…”