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Images of Memorable Cases: Case 119

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_119-pres1-1.jpg

Case_119-pres1-2.jpg Case_119-pres1-3.jpg

This 40-year-old man complained of puffy eyes, dry skin, and muscle stiffness of six months’ duration.

119. Hypothyroid myopathy

Hoffmann’s syndrome. In addition to puffy eyelids and dry skin, this patient had a markedly delayed relaxation phase of his deep tendon reflexes and prominent enlargement of his right calf. On palpation, the calf was firm but not tender. These physical findings prompted thyroid hormone replacement 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 severe hypothyroidism. The cause of the increased muscle mass awaits clarification. On histopathologic examination, the involved muscles have densely packed fibers with 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 be affected. Thyroid hormone therapy is curative.

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