Hypothyroidism presenting with musculoskeletal symptoms.

-The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major symptoms related are weakness, muscular cramps and myalgia. The pseudohyperthrophic form is called Hoffman's syndrome. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with thyrotrophic-stimulating hormone (TSH) elevated. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report an adult male who developed muscular cramps, myalgia, weakness, pseudohyperthrophy, associated with facial edema and alteration of his voice. The muscle enzymes were increased and T4 was undetectable with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in this case. Resumo -A frequência de miopatia no hipotireoidismo varia de 30% a 80%. Os sintomas relacionados ao acometimento muscular são fraqueza, cãimbras e mialgias. A forma pseudo-hipertrófica é denominada síndrome de Hoffman. O estudo eletrofisiológico pode revelar padrão miopático, neuropático ou misto. A investigação laboratorial em geral mostra aumento das enzimas musculares e redução dos níveis de hormônio tireoidiano com TSH elevado. O tratamento consiste na reposição oral de hormônio e o prognóstico é bom na maioria dos casos. Relatamos o caso de um adulto que apresentou cãimbras, mialgia, fraqueza com pseudohipertrofia muscular associados a edema facial e alteração da voz. As enzimas musculares estavam elevadas e o nível de T4 foi indetectável com aumento de TSH. A miopatia foi manifestação inicial de hipotireoidismo neste caso.

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“…The adult pseudohypertrophic form is named Hoffman syndrome 10 . It is a rare syndrome described by Hoffman in 1897.…”

Section: Discussionmentioning

confidence: 99%

Hoffman's syndrome: pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report

Vasconcellos

Peixoto

Oliveira

et al. 2003

Arq. Neuro-Psiquiatr.

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“…Symptoms were selected for study by first compiling a list of 29 symptoms of hypothyroidism from the literature and the work of previous investigators. 3,4,7,18,19,22 General internists and endocrinologists were surveyed to determine which symptoms were most suggestive of hypothyroidism in their clinical experience. The final questionnaire included the symptoms reported most often in the survey.…”

Section: Symptom Assessmentmentioning

confidence: 99%

“…[1][2][3][4] Yet hypothyroidism often remains undetected because of the difficulty with ascribing symptoms to disease. The pathophysiologic changes generally require months or years to manifest as clinical signs and symptoms.…”

mentioning

confidence: 99%

Do traditional symptoms of hypothyroidism correlate with biochemical disease?

1997

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OBJECTIVE:Hypothyroidism often remains undetected because of the difficulty associating symptoms with disease. To determine the relation between symptoms and biochemical disease, we assessed symptoms and serum thyroid function tests, concurrently, for patients with and without hypothyroidism. DESIGN:Cross-sectional study. SETTING/PATIENTS: CONCLUSIONS:In this sample, the number of hypothyroid symptoms reported was directly related to the level of TSH. The association was stronger when more symptoms were reported. Symptoms that had changed in the past year were more powerful than symptoms reported present at the time of testing. This suggests that traditional symptoms are valuable when deciding which patients to test for hypothyroidism.

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“…18 Golding DN demonstrated a delayed DTR in patients with hypothyroidism which is similar to the observation in our study. 19 Hypothyroidism is also found to increase the risk for critical mood deterioration by seven fold in a research work carried by Larisch R et al 20 Bipolar affective disorders are found to be associated with the occurrence of hypothyroidism and its treatment, which was demonstrated in a study conducted by Bauer MS et al 21 The strength of the present study is that a comprehensive evaluation of all the symptoms and signs was done in patients with hypothyroidism. Also standard diagnostic criteria and examination guidelines were followed and performed by various experts in the concerned fields for clinical examination of all the patients.…”

Section: Discussionmentioning

confidence: 56%