Neurological manifestations of hypothyroidism are not usually seen early in the course of the disease, particularly muscle disease. Entrapment neuropathy is more common and may be a presenting symptom. Hypothyroidism presenting as muscle stiffness and pseudohypertrophy in adults is known as Hoffman’s syndrome which is supported by presence of elevated CPK and EMG features of myopathy, neuropathy or mixed pattern. With hormone replacement therapy symptoms and CPK levels normalize promptly. We report a case of hypothyroidism with extreme muscle pain, calf muscle hypertrophy as initial symptoms.

1. Sidibe EH, Diop AN, Thiam A, Diagne PM, Sarr A, Toure M, et al.A Hoffmann's Syndrome in hypothyroid myopathy. Report of a case in an African. Joint Bone Spine 2001;68:84-5. 
2. Ozdag MF, Eroglu E, Ulas UH, Ipekdal I, Odabasý Z, Vural O. Early diagnosis and treatment reverse clinical features in Hoffmann's syndrome due to hypothyroid myopathy: A case report. Acta Neurol Belg2005;105:212-3
3. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: A prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 2000;68:750-5.
4. Udayakumar N, Rameshkumar AC, Srinivasan AV. Hoffmann syndrome: Presentation in hypothyroidism. J Postgrad Med. 2005;51:332–3
5. Scott KR, Simmons Z, Boyer PJ. Hypothyroid myopathy with a strikingly elevated serum creatine kinase level. Muscle Nerve. 2002;26:141–4.
6. Melmed S, Polonsky KS, Reed Larsen P, Kronenberg HM. Williams Textbook of Endocrinology.12th ed. Philadelphia: W.B. Saunders Company; 2011. The thyroid gland; p. 410
7. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. J Indian Med Assoc. 2004; 102:41–2
8. Scott KR, Simmons Z, Boyer PJ. Hypothyroid myopathy with a strikingly elevated serum creatine kinase levels. Muscle Nerve 2002;26:141-4.
9. Praveen K, Aslam S, Dutta T K. HoffMann's syndrome: A rare neurological presentation of hypothyroidism. Int J Nutr Pharmacol Neurol Dis 2011;1:201-3
10. McKeran RO, Slavin G, Ward P, Paul E, Mair WGP. Hypothyroid myopathy: a clinical and pathological study. J Pathol1980;132:35-54

Dr H Subramony

Consultant Physician, Apollo Hospitals, Greams Road, Chennai 600006, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., PH: 9841073910