SHM Converge Scientific Abstract ePoster Gallery-Clinical Cost-Saving Clues: A Case of Diagnosing a Rare Hypothyroid Myopathy

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This case describes a 61-year-old man with a history of hypothyroidism, obesity, chronic kidney disease, hypertension, and prior nephrectomy/adrenalectomy who presented to the emergency department unable to rise from his recliner. He reported months of progressive lower-extremity myalgia and weakness, with bilateral hip and ankle pain. He admitted he had not seen a physician in over a year and was only taking propranolol at home.<br /><br />On exam, he had severe pain with active and passive movement of the legs, stiff lower extremities, painful bilateral hip flexor weakness, and globally reduced reflexes. Because of pain and obesity, calf pseudohypertrophy was difficult to assess. Laboratory testing showed markedly elevated creatine kinase (CK 1,047 U/L, peaking at 1,737 U/L), very high TSH (59.3 uIU/mL), and low free T4 (0.10 ng/dL), consistent with profound untreated hypothyroidism.<br /><br />He was treated with IV levothyroxine, aggressive IV fluids, and stress-dose steroids because of his adrenalectomy history. Neurology concluded clinically that his myopathy was Hoffmann syndrome, a rare form of hypothyroid myopathy characterized by proximal muscle weakness, stiffness, cramps, and often calf pseudohypertrophy in men with longstanding untreated hypothyroidism. His muscle pain gradually improved, he was transitioned to oral levothyroxine, and he was discharged to a skilled nursing facility for rehabilitation.<br /><br />The main point of the report is that Hoffmann syndrome can often be diagnosed clinically using exam findings plus elevated CK and thyroid studies, avoiding more expensive imaging or invasive testing that would not change management.

Asset Subtitle

Andrea Lauffer

Meta Tag

Author List Andrea Lauffer, Pascal Aliihnui Atanga

Category Clinical Vignettes

Concept Hoffmann Syndrome

Concept Hypothyroidism

Concept Hypothyroid Myopathy

Concept Proximal Muscle Weakness

Concept Calf Pseudohypertrophy

Distinguished Non-Finalist

Presenter Organization Thomas Hospital-West Virginia University

Presenting Author Andrea Lauffer

Track Adult

Keywords

Hoffmann syndrome

hypothyroid myopathy

untreated hypothyroidism

proximal muscle weakness

elevated creatine kinase

calf pseudohypertrophy

muscle stiffness

levothyroxine treatment

thyroid-stimulating hormone

myalgia

Hoffmann Syndrome

Hypothyroidism

Hypothyroid Myopathy

Proximal Muscle Weakness

Calf Pseudohypertrophy