Images of Memorable Cases: Case 31 This 53-year-old college professor could no longer lecture because her tongue kept getting in the way. Her tongue was enlarged and had serrations, reflecting imprints of her teeth. Her upper-torso muscles were grossly hypertrophied and hard as wood; they looked like “shoulder pads.” 31. Systemic amyloidosis An enlarged, serrated tongue suggests amyloidosis, acromegaly, or hypothyroidism. The “shoulder pad” sign, however, is relatively specific for amyloid disease. Thus, the combination of an enlarged, serrated tongue with the "shoulder pad" sign is pathognomonic of systemic amyloidosis.