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Myopathies associated with hypothyroidism: A review based upon 13 cases. We report a case of hypothyroidism with calf muscle hypertrophy and proximal myopathy as the initial symptoms. We present a case of Hoffman's disease with predominant proximal myopathy and myotonia. JK Science 2011;13:190-2. After 1 month therapy her hypothyroid symptoms reduced, pseudohypertrophy of the calf muscles regressed, muscle enzymes were reduced. , Chopra et al., noticed hypertrophy of almost all muscles of body, especially calf and arm muscles. Thyroid hormone deficiency is a rare cause of acquired myopathy, comprising only 5% of the total cases. J Postgrad Med 2005;51:332-3. NV Sundarachari1, A Sridhar2, Vijaya P Lakshmi2 Absolute calf enlargement is a frequent finding in patients with neuromuscular diseases. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. 'Myxoedematous pseudo-myotonia' refers to significant muscular weakness associated with delayed muscle contraction as well as relaxa-tion. PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. Treatment of peripheral neuropathy due to hypothyroidism is directed at managing the underlying hypothyroidism and treating the resulting symptoms. The muscle hypertrophy and muscle weakness receded following hormone replacement therapy with thyroid hormones. Different foot positioning during calf training to induce portion-specific gastrocnemius muscle hypertrophy. Myalgia without muscular hypertrophy. Aust N Z J Med 1988;18:799-806. Qureshi W, Hassan G, Khan GQ, Kadri SM, Kak M, Ahmad M. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. Arq Neuropsiquiatr 2003;61:851-4. The boy was found to have hypothyroidism [TSH= 807 ,8 /ml (0 .5 ± 4 .8 ), free T 4 = 5 .15 pmol /l (11 -18 ,6 )]. Ann Rheum Dis 1968;27:590-6. We found an absolute calf hypertrophy in more than every fifth patient, 80% being true and 20% pseudohypertrophies. Udayakumar N, Rameshkumar AC, Srinivasan AV. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Early diagnosis and treatment reverse clinical features in Hoffmann's syndrome due to hypothyroid myopathy: A case report. See your doctor if you know or suspect you have hypothyroidism and you're having troubling or painful symptoms in your limbs. Hoffmann syndrome is a rare form of hypothyroid myopathy in adults characterized by presence of muscle weakness, stiffness and pseudohypertrophy. The muscle involvement in hypothyroidism is caused by changes in muscle fibres from fast twitching type II to slow twitching type-I fibres. When a patient develops hypothyroidism, it means the number of Thyroid hormones in their body has become too low. In Williams textbook of endocrinology, 11. Hypothyroid myopathy with a strikingly elevated serum creatine kinase levels. Calf muscle pain is often caused by overuse or a sports injury. Please note that these are averages based on our personal training experience and, accrued through training thousands of clients over the course of many years. Results: Brain imaging findings showed pituitary enlargement. This type of injury often occurs during athletic activities that require abrupt pushing off from the foot, such as during racket sports or soccer. muscle hypertrophy with enlargement of the calf muscles . Reviews in Endocrine and Metabolic Disorders. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Praveen, Sarfaraz Aslam, TK Dutta Neu­ romuscular findings in thyroid dysfunction: a prospective clinical and This report describes an adolescent male presenting with typical features of this rare … Hoffmann's syndrome is very rare condition and its initial presentation with myopathic manifestations can raise diagnostic problems as calf muscle hypertrophy can present in other diseases as well, like Duchenne and Becker's muscular dystrophy, amyloidosis, and focal myositis. (1) Pseudo hypertrophy of muscles comprised 18.7% of cases with a 2:1 female to male ratio, and it was found in various forms of hypothyroidism. On the basis of results of calf muscle biopsies, it seems likely that the enlargement was due to muscle fiber hypertrophy and atrophy combined with an increase in connective tissue. J Indian Med Assoc 2004;102:41-2. Since delayed return ofthe ankle-jerks occurs Fessel WJ. Neuromuscular findings in thyroid dysfunction: A prospective clinical and electrodiagnostic study. It's diagnosis is also difficult. Muscle Nerve 2002;26:141-4. Keywords: Hashimoto′s thyroiditis; Hoffmann′s syndrome; pseudo hypertrophy of muscles; thyroid peroxidase antibodies. Even though the muscle appears enlarged, it is weak and so the affliction is pseudo hypertrophy especially of the calf muscles. Abstract. Muscle features causing hypertrophy Common: Fat infiltration; Connective tissue proliferation Especially calf ± other muscles Muscle fiber hypertrophy Mass: Neoplasm or Focal myositis. The presentation of hypothyroidism may be with polymyositis-like syndrome, serum TSH levels should be routinely tested in all patients wit… Cysticercosis Trichinosis; Schistosomiasis Drug treatment. The thyroid gland. Calf pseudohypertrophy is typical. PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. HoffMann's syndrome: A rare neurological presentation of hypothyroidism He had hypertrophy of calf muscles and the thyroid profile showed low levels of T3, T4 and markedly elevated level of thyroid-stimulating hormone thus confirming the presence of hypothyroidism. Hypothyroid myopathy or Hoffman's syndrome is a rare manifestation of a common condition. Kocher-Debre-Semelaigne syndrome (KDSS) is a rare association of muscular pseudohypertrophy and long-standing moderate-to-severe hypothyroidism in the pediatric age group. Hoffmann syndrome: Presentation in hypothyroidism. The neurological manifestations of hypothyroidism are very unusual to see as initial symptoms and they usually occur late in the course of disease. Research Journal of Radiology. Mastaglia FL, Ojeda VJ, Sarnat HB, Kakulas BA. The condition is rare in countries with screening programmes for hypothyroidism at birth. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Calf hypertrophy develops in a wide range of myopathic conditions; clinical acumen, electrophysiology and possibly muscle biopsy remain important to avoid a potentially fruitless genetic quest. 2016; 4(1): 1. Treatment. Udaya kumar N, Ramesh kumar AC, Srinivasan AV: Hoffmann syndrome: Presentation in hypothyroidism. β 2 adrenergic agonists: Albuterol; Clenbuterol Androgenic steroids Storage & replacement We studied seven patients with S-1 radiculopathy who developed ipsilateral enlargement of the calf. Keywords: Hoffman′s disease, hypothyroid myopathy, myotonia, https://www.jdrntruhs.org/text.asp?2013/2/3/203/117190. Ozdag MF, Eroglu E, Ulas UH, Ipekdal I, Odabasý Z, Vural O. This combination of hypothyroidism and hypertrophy of muscles is classically described as Kocher–Debré–Semelaigne syndrome. Acta Neurol Belg 2005;105:212-3. Myopathy of hypothyroidism. J Postgrad Med 2005;51:332-3. 2014; 3(18): 4772, International Archives of Medicine. However, it can also indicate an underlying medical issue, including deep vein … The following are some helpful tips for your calf training. https://www.ijnpnd.com/text.asp?2011/1/2/201/84215. Rudrajit P, Sinha PK, Mondal P, Banerjee AK. Inclusion body myositis. hypothyroidism and calf muscle hypertrophy make it very easy to pick it up. 2014; 7(1): 2, © International Journal of Nutrition, Pharmacology, Neurological Diseases | Published by Wolters Kluwer -. Hoffman syndrome as first manifestation of hypothyroidism: A rare case. 1 Department of Neurology, Guntur Medical College, Guntur, Andhra Pradesh, India2 Department of General Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India, Correspondence Address:A SridharFF-5 PG Hostel, Government General Hospital, Guntur - 522 001, Andhra Pradesh IndiaSource of Support: None, Conflict of Interest: NoneCheckDOI: 10.4103/2277-8632.117190 function RightsLinkPopUp () { var url = "https://s100.copyright.com/AppDispatchServlet"; var location = url + "?publisherName=" + encodeURI ('Medknow') + "&publication=" + encodeURI ('JNTR') + "&title=" + encodeURI ('Rare yet treatable: Hypothyroid myopathy (Hoffman\'s syndrome)') + "&publicationDate=" + encodeURI ('Jul 1 2013 12:00AM') + "&author=" + encodeURI ('Sundarachari N V, Sridhar A, Lakshmi VP') + "&contentID=" + encodeURI ('JNTRUnivHealthSci_2013_2_3_203_117190') + "&orderBeanReset=true" Pain occurs suddenly at the time of the injury and a knot at the top of the calf might appear. Hypothyroidism and Muscle Weakness. Calf hypertrophy is a typical clinical feature in neuromuscular diseases such as X-linked muscular dystrophies of Duchenne and Becker type and can be seen as an atypical feature in numerous other diseases. The electrophysiological study may reveal features suggestive of myopathy, neuropathy or mixed pattern. 3. Calf muscle hypertrophy accompanies a wide variety of diseases like Duchenne and Becker muscle dystrophy, infiltration by sarcoid granulomas, amyloid deposits and focal myositis. The boy was found to have hypothyroidism [TSH=807 μIU/ml (0.5–4.8), free … Case report. He showed muscle hypertrophy with enlargement of the calf muscles. HS is a very rare form of hypothyroid myopathy in adults that causes proximal weakness and muscle hypertrophy. J Indian Med Assoc 2004;102:41–2. Muscle hypertrophy as first presentation of hypothyroidism is quite rare. Other injuries might also cause swelling, such as a calf muscle strain, or tear. To stay rooted in the theoretical and practical bases on which the upcoming recommendations are made, before proceeding, please be sure you've read the introductory a… very rare, muscular hypertrophy occurring in infants with cretinism. Hashimoto's thyroiditis; Hoffmann's syndrome; pseudo hypertrophy of muscles; thyroid peroxidase antibodies. One example is Hoffman's syndrome, in which a person develops diffuse muscle hypertrophy (enlarged muscles) leading to significant muscle stiffness, weakness, and pain. although never in any type of rhythmic sequence that could qualify as dancing Calf muscle hypertrophy in Pompe's disease is a seldom quoted sign, the exact incidence being unknown. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. Computed tomograms of the legs revealed no evidence of tumor. He had hoarsenessof voice, a dry texture of skin, a macroglossia andan odematous face (Pic. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. J Neurol Neurosurg Psychiatr 2000;68:750-5. Sidibe EH, Diop AN, Thiam A, Diagne PM, Sarr A, Toure M, Reed Larsen P, Henry MK, Shlomo Melmed, Kenneth SP. 2016; Journal of Evolution of Medical and Dental Sciences. The presentation of an adolescent female with limb-girdle pattern of weakness and calf hypertrophy had initially led to the consideration of other myopathies including limb … Hoffman's syndrome: Pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Along with features of hypothyroidism the main additional feature is muscle hypertrophy.It can happen in any muscle of the limbs, but commonly affects the proximal muscles giving the typical Hercules appearance. J Assoc Physicians India 2010;58:569-70. Research Journal of Radiology. Achilles tendon 0005109 Calf muscle hypertrophy Increased size of calf muscles 0008981 Generalized hypotonia Decreased muscle tone Low muscle tone [ more ] 0001290 Pelvic [rarediseases.info.nih.gov] Overgrowth ( hypertrophy ) of the calf muscles occurs in some … Infections. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Rare yet treatable: Hypothyroid myopathy (Hoffman's syndrome) He was diagnosed to have proximal muscle weakness and pseudohypertrophy of calf muscles due to primary hypothyroidism. There are a few cases reported in India. It may also cause muscle weakness or loss of muscle control. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. This hypertrophy is reversible with treatment. The recommendations here should be food for thought or places to start, not dogmatic scriptures to follow to the letter. Calf hypertrophy can be feigned by atrophy of the quadriceps muscles, then referred to as relative calf hypertrophy. Such presentation can … Therefore special awareness about this syndrome will lead to the correct diagnosis. Hypothyroidism. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman’s syndrome. The symptoms and also the serum levels of enzymes return to normal with hormone replacement therapy. Straining of the soleus muscle is commonly a chronic injury that occurs in long-distance runners. Muscular hypertrophy is present, but … Thyroid dysgenesis was the most common etiology (80.9%), (2) Calf muscles involvement is a rare clinical presentation of hypothyroidism… The diagnosis of calf hypertrophy usually is based on subjective visual assessment. Although cardiac manifestations of hypothyroidism are well known, reports of cardiac involvement in KDS have only described the occurrence of pericardial effusion as an association. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, Correspondence Address:K.A.S. K.A.S. Vasconcellos LF, Peixoto MC, de Oliveira TN, Penque G, Leite AC. 1 ). He had hoarseness of voice, a dry texture of skin, a macroglossia and an odematous face. J Indian Med Assoc 2004;102:41-2. Madhu SV, Jain R, Kant S, Prakash V, Kumar V. Myopathy presenting as a sole manifestation of hypothyroidism. Neurogenic disorders can cause muscle hypertrophy and particularly autosomal recessive spinal muscular atrophy; several clinical clues can help to distinguish these from myopathic disorders. Our case showed predominantly myopathy with minimal systemic manifestations of hypothyroidism. The soleus muscle is located underneath the gastrocnemius muscle in the calf. B rain imaging findings showed pituitary enlargement. 2  Rhabdomyolysis (when muscle breaks down rapidly) is another rare muscular manifestation of hypothyroidism. Rarely, hypothyroidism can cause more severe muscle symptoms. Kocher-Debre-Semelaigne (KDS) syndrome is a rare form of hypothyroid myopathy, with associated hypertrophy of muscles. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. However, they are not uncommon in the countries where such routine screening programmes are not available, the diagnosis of … Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. 2016; 4(1): 1, © Journal of Dr. NTR University of Health Sciences | Published by Wolters Kluwer -. Figure 4: Resolution of calf muscle hypertrophy after 6 months of treatment 2. J Assoc Physicians India 1972;20:387-90. PraveenDepartment of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry IndiaSource of Support: None, Conflict of Interest: NoneCheckDOI: 10.4103/2231-0738.84215 function RightsLinkPopUp () { var url = "https://s100.copyright.com/AppDispatchServlet"; var location = url + "?publisherName=" + encodeURI ('Medknow') + "&publication=" + encodeURI ('IJNP') + "&title=" + encodeURI ('HoffMann\'s syndrome: A rare neurological presentation of hypothyroidism') + "&publicationDate=" + encodeURI ('Jul 1 2011 12:00AM') + "&author=" + encodeURI ('Praveen K, Aslam S, Dutta T K') + "&contentID=" + encodeURI ('IntJNutrPharmacolNeurolDis_2011_1_2_201_84215') + "&orderBeanReset=true" The differential diagnosis of muscle hypertrophy includes myotonia congenita, hypothyroidism, amyloidosis, Isaacs syndrome, some forms of limb girdle muscular dystrophies, myotubular myopathy, dystroph-inopathies such as Becker's dystrophy, stiff-person syndrome, amyloidosis, Schwartz-Jampel syndrome, and parasite infestations. 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In countries with screening programmes for hypothyroidism at birth syndrome in adults known! Develop muscular pseudohypertrophy and long-standing moderate-to-severe hypothyroidism in the course of disease may muscular! Pseudohypertrophy is typical minimal systemic manifestations of hypothyroidism and you 're having troubling or painful symptoms in limbs! A strikingly elevated serum creatine kinase levels kumar AC, Srinivasan AV: Hoffmann syndrome presentation. Reverse clinical features in Hoffmann 's syndrome ( hypothyroid myopathy or Hoffman 's disease with predominant myopathy!

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