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This 53-year-old college professor could no longer lecture because her tongue kept getting in the way. Her tongue was enlarged andhad serrations, reflecting imprints of her teeth. Her upper-torso muscles were grossly hypertrophied and hard as wood; they looked like “shoulder pads.”
An enlarged, serrated tongue suggests amyloidosis, acromegaly, or hypothyroidism. The “shoulder pad” sign, however, is relativelyspecific for amyloid disease. Thus, the combination of an enlarged, serrated tongue with the "shoulder pad" sign is pathognomonic of systemicamyloidosis.
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