Mohammed Nasir Uddin^1,, Abbas Uddin², Mohammed Abbas Uddin Chy³, Taslima Khan⁴

Hypothyroidism is one of the most prevalent endocrine disorders. Different neuromuscular complications can develop with hypothyroidism. Nonspecific neuromuscular complaints like myalgia, muscle cramps and mild elevation of Creatine Kinase (CK) are the most common myopathic features related to hypothyroidism. Other myopathic features included proximal muscle weakness and myxoedema. The neurological manifestations of hypothyroidism are very unusual to see as initial symptoms and they usually occur late in the course of disease. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. The electrophysiological study may reveal features suggestive of myopathy, neuropathy or mixed pattern. The symptoms and also the serum levels of enzymes return to normal with hormone replacement therapy. We report a case of hypothyroidism with calf muscle hypertrophy and proximal myopathy as the initial symptoms.

hypothyroidism, pseudo hypertrophy, Hoffmann’s syndrome