0.106 Images of memorable cases: case 119

119. hypothyroid myopathy

Hoffmann’s syndrome. In addition to puffy eyelids and dry skin, this patient had a markedly delayed relaxation phase of his deeptendon reflexes and prominent enlargement of his right calf. On palpation, the calf was firm but not tender. These physical findings prompted thyroid hormonereplacement therapy, and within six months, all of the aforementioned abnormalities disappeared.

Hoffman’s syndrome refers to varying degrees of weakness, muscle stiffness, and increased muscle mass in adults with severehypothyroidism. The cause of the increased muscle mass awaits clarification. On histopathologic examination, the involved muscles have densely packed fiberswith variable diameters and loss of normal striations. One or both calf muscles are among the more commonly involved sites, but almost any muscle group may beaffected. Thyroid hormone therapy is curative.