Hypothyroid Myopathy with Manifestations of Hoffman's Syndrome and Myasthenia Gravis

Abstract

Although hypothyroid myopathy is seen frequently and the relationship with autoimmune hypothyroidism and myasthenia gravis is well known, specific forms of hypothyroid myopathy such as Hoffman's syndrome (HS) are rarely described. Here we describe a 40-year-old patient with Hashimoto thyroiditis showing symptoms and signs of two discrete forms of hypothyroid myopathy (HS and myasthenic syndrome) together. To our knowledge this is the first reported case with features of both of these syndromes. We discuss the diagnosis, speculate whether this patient may represent a unique form of hypothyroid myopathy, and report the 6-month follow-up of the patient both clinically and electrophysiologically.

Hoff Mann′s syndrome with unusually long duration: Report on clinical, laboratory and muscle imaging findings in two cases

“…Treatment is levothyroxine supplement leads to remarkable results and subsidence of muscle hypertrophy in most of the cases[5111217] and the same was noted in our cases too. It was interesting to note that the hypertrophied, edematous muscles reduced in size and rather showed atrophy.…”

“…[4] Presentation as a persistently isolated myopathy is extremely rare and HS is even rarer. [12349101112]…”

“…Case 1 had an illness duration of 13 years and case 2, more than 20 years, while in previous reports the illness duration had ranged from 1 month to maximum of 2 years only. [1112] Hypothyroid patients may experience myopathy, mononeuropathy or sensorimotor axonal polyneuropathy. [413] Case 1 had subclinical electrophysiological evidence of diffuse sensory motor neuropathy.…”

“…[1112] Hypothyroid patients may experience myopathy, mononeuropathy or sensorimotor axonal polyneuropathy. [413] Case 1 had subclinical electrophysiological evidence of diffuse sensory motor neuropathy. This patient also had features of hyperactive tendon reflexes.…”

Hypothyroid myopathy mimicking postpolio syndrome

“…Occasionally, Hashimoto's thyroiditis can even present with Hoffman's syndrome which characterised by proximal weakness and muscle hypertrophy 13. Turker et al 14 reported a case of Hashimoto's thyroiditis-induced myopathy with coexisting myaesthenic and Hoffman syndrome-like presentation. The other common causes of proximal weakness are vitamin D deficiency, Cushing syndrome, adrenal dysfunction and pituitary dysfunction.…”