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calf muscle hypertrophy in hypothyroidism

Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Myopathy of hypothyroidism. Myalgia without muscular hypertrophy. The presentation of an adolescent female with limb-girdle pattern of weakness and calf hypertrophy had initially led to the consideration of other myopathies including limb … This combination of hypothyroidism and hypertrophy of muscles is classically described as Kocher–Debré–Semelaigne syndrome. We report a case of hypothyroidism with calf muscle hypertrophy and proximal myopathy as the initial symptoms. This type of injury often occurs during athletic activities that require abrupt pushing off from the foot, such as during racket sports or soccer. One example is Hoffman's syndrome, in which a person develops diffuse muscle hypertrophy (enlarged muscles) leading to significant muscle stiffness, weakness, and pain. In both children andadults, the hypertrophy is reversible on return to the euthyroid state. J Postgrad Med 2005;51:332-3. Treatment of peripheral neuropathy due to hypothyroidism is directed at managing the underlying hypothyroidism and treating the resulting symptoms. HoffMann's syndrome: A rare neurological presentation of hypothyroidism The neurological manifestations of hypothyroidism are very unusual to see as initial symptoms and they usually occur late in the course of disease. Hoffman's syndrome: Pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. The muscle involvement in hypothyroidism is caused by changes in muscle fibres from fast twitching type II to slow twitching type-I fibres. Chopra BK, Singh G, Puri A. Hoffman's syndrome (hypothyroid myopathy). PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. Cysticercosis Trichinosis; Schistosomiasis Drug treatment. 2  Rhabdomyolysis (when muscle breaks down rapidly) is another rare muscular manifestation of hypothyroidism. Muscle Nerve 2002;26:141-4. Neurogenic disorders can cause muscle hypertrophy and particularly autosomal recessive spinal muscular atrophy; several clinical clues can help to distinguish these from myopathic disorders. Even though the muscle appears enlarged, it is weak and so the affliction is pseudo hypertrophy especially of the calf muscles. This hypertrophy is reversible with treatment. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. J Indian Med Assoc 2004;102:41-2. However, it can also indicate an underlying medical issue, including deep vein … Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. To stay rooted in the theoretical and practical bases on which the upcoming recommendations are made, before proceeding, please be sure you've read the introductory a… Hashimoto's thyroiditis; Hoffmann's syndrome; pseudo hypertrophy of muscles; thyroid peroxidase antibodies. muscle hypertrophy with enlargement of the calf muscles . Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. We present a case of Hoffman's disease with predominant proximal myopathy and myotonia. Muscle hypertrophy as first presentation of hypothyroidism is quite rare. https://www.ijnpnd.com/text.asp?2011/1/2/201/84215. Hoffman syndrome as first manifestation of hypothyroidism: A rare case. In Williams textbook of endocrinology, 11. 1 ). Scott KR, Simmons Z, Boyer PJ. PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. Calf muscle hypertrophy accompanies a wide variety of diseases like Duchenne and Becker muscle dystrophy, infiltration by sarcoid granulomas, amyloid deposits and focal myositis. Since delayed return ofthe ankle-jerks occurs Calf pseudohypertrophy is typical. He was diagnosed to have proximal muscle weakness and pseudohypertrophy of calf muscles due to primary hypothyroidism. very rare, muscular hypertrophy occurring in infants with cretinism. Hypothyroidism. Hypothyroidism and Muscle Weakness. J Indian Med Assoc 2004;102:41–2. The condition is rare in countries with screening programmes for hypothyroidism at birth. Such presentation can … 2014; 3(18): 4772, International Archives of Medicine. Different foot positioning during calf training to induce portion-specific gastrocnemius muscle hypertrophy. , Chopra et al., noticed hypertrophy of almost all muscles of body, especially calf and arm muscles. Thyroid hormone deficiency is a rare cause of acquired myopathy, comprising only 5% of the total cases. J Assoc Physicians India 2010;58:569-70. Acta Neurol Belg 2005;105:212-3. Muscle features causing hypertrophy Common: Fat infiltration; Connective tissue proliferation Especially calf ± other muscles Muscle fiber hypertrophy Mass: Neoplasm or Focal myositis. Results: Brain imaging findings showed pituitary enlargement. Abstract. Other injuries might also cause swelling, such as a calf muscle strain, or tear. Rarely, hypothyroidism can cause more severe muscle symptoms. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Case report. Figure 4: Resolution of calf muscle hypertrophy after 6 months of treatment 2. Early diagnosis and treatment reverse clinical features in Hoffmann's syndrome due to hypothyroid myopathy: A case report. Hoffmann's syndrome is very rare condition and its initial presentation with myopathic manifestations can raise diagnostic problems as calf muscle hypertrophy can present in other diseases as well, like Duchenne and Becker's muscular dystrophy, amyloidosis, and focal myositis. Madhu SV, Jain R, Kant S, Prakash V, Kumar V. Myopathy presenting as a sole manifestation of hypothyroidism. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. Hypothyroid myopathy with a strikingly elevated serum creatine kinase levels. Rudrajit P, Sinha PK, Mondal P, Banerjee AK. Rare yet treatable: Hypothyroid myopathy (Hoffman's syndrome) It's diagnosis is also difficult. Calf hypertrophy is a typical clinical feature in neuromuscular diseases such as X-linked muscular dystrophies of Duchenne and Becker type and can be seen as an atypical feature in numerous other diseases. The presentation of hypothyroidism may be with polymyositis-like syndrome, serum TSH levels should be routinely tested in all patients wit… Muscular hypertrophy is present, but … 2016; 4(1): 1. Udayakumar N, Rameshkumar AC, Srinivasan AV. The boy was found to have hypothyroidism [TSH= 807 ,8 /ml (0 .5 ± 4 .8 ), free T 4 = 5 .15 pmol /l (11 -18 ,6 )]. Neu­ romuscular findings in thyroid dysfunction: a prospective clinical and When a patient develops hypothyroidism, it means the number of Thyroid hormones in their body has become too low. Inclusion body myositis. β 2 adrenergic agonists: Albuterol; Clenbuterol Androgenic steroids Storage & replacement There are a few cases reported in India. 2016; Journal of Evolution of Medical and Dental Sciences. Calf hypertrophy develops in a wide range of myopathic conditions; clinical acumen, electrophysiology and possibly muscle biopsy remain important to avoid a potentially fruitless genetic quest. J Postgrad Med 2005;51:332-3. PraveenDepartment of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry IndiaSource of Support: None, Conflict of Interest: NoneCheckDOI: 10.4103/2231-0738.84215 function RightsLinkPopUp () { var url = "https://s100.copyright.com/AppDispatchServlet"; var location = url + "?publisherName=" + encodeURI ('Medknow') + "&publication=" + encodeURI ('IJNP') + "&title=" + encodeURI ('HoffMann\'s syndrome: A rare neurological presentation of hypothyroidism') + "&publicationDate=" + encodeURI ('Jul 1 2011 12:00AM') + "&author=" + encodeURI ('Praveen K, Aslam S, Dutta T K') + "&contentID=" + encodeURI ('IntJNutrPharmacolNeurolDis_2011_1_2_201_84215') + "&orderBeanReset=true" Hoffmann syndrome: Presentation in hypothyroidism. The following are some helpful tips for your calf training. The thyroid gland. Infections. Pain occurs suddenly at the time of the injury and a knot at the top of the calf might appear. The symptoms and also the serum levels of enzymes return to normal with hormone replacement therapy. Kocher-Debre-Semelaigne syndrome (KDSS) is a rare association of muscular pseudohypertrophy and long-standing moderate-to-severe hypothyroidism in the pediatric age group. K.A.S. Treatment. although never in any type of rhythmic sequence that could qualify as dancing Ann Rheum Dis 1968;27:590-6. The muscle hypertrophy and muscle weakness receded following hormone replacement therapy with thyroid hormones. The boy was found to have hypothyroidism [TSH=807 μIU/ml (0.5–4.8), free … NV Sundarachari1, A Sridhar2, Vijaya P Lakshmi2 (1) Pseudo hypertrophy of muscles comprised 18.7% of cases with a 2:1 female to male ratio, and it was found in various forms of hypothyroidism. 'Myxoedematous pseudo-myotonia' refers to significant muscular weakness associated with delayed muscle contraction as well as relaxa-tion. Mastaglia FL, Ojeda VJ, Sarnat HB, Kakulas BA. The electrophysiological study may reveal features suggestive of myopathy, neuropathy or mixed pattern. Computed tomograms of the legs revealed no evidence of tumor. The diagnosis of calf hypertrophy usually is based on subjective visual assessment. Thyroid dysgenesis was the most common etiology (80.9%), (2) Calf muscles involvement is a rare clinical presentation of hypothyroidism… Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman’s syndrome. Muscle hypertrophy is an extremely rare finding in hypothyroid patients. He had hypertrophy of calf muscles and the thyroid profile showed low levels of T3, T4 and markedly elevated level of thyroid-stimulating hormone thus confirming the presence of hypothyroidism. Reviews in Endocrine and Metabolic Disorders. Along with features of hypothyroidism the main additional feature is muscle hypertrophy.It can happen in any muscle of the limbs, but commonly affects the proximal muscles giving the typical Hercules appearance. Hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy in adults is known as Hoffmann's syndrome. Therefore special awareness about this syndrome will lead to the correct diagnosis. Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. Absolute calf enlargement is a frequent finding in patients with neuromuscular diseases. Kocher-Debre-Semelaigne (KDS) syndrome is a rare form of hypothyroid myopathy, with associated hypertrophy of muscles. The recommendations here should be food for thought or places to start, not dogmatic scriptures to follow to the letter. After 1 month therapy her hypothyroid symptoms reduced, pseudohypertrophy of the calf muscles regressed, muscle enzymes were reduced. We found an absolute calf hypertrophy in more than every fifth patient, 80% being true and 20% pseudohypertrophies. Ozdag MF, Eroglu E, Ulas UH, Ipekdal I, Odabasý Z, Vural O. He had hoarseness of voice, a dry texture of skin, a macroglossia and an odematous face. JK Science 2011;13:190-2. Arq Neuropsiquiatr 2003;61:851-4. J Indian Med Assoc 2004;102:41-2. 3. Udaya kumar N, Ramesh kumar AC, Srinivasan AV: Hoffmann syndrome: Presentation in hypothyroidism. Calf muscle pain is often caused by overuse or a sports injury. Keywords: Hoffman′s disease, hypothyroid myopathy, myotonia, https://www.jdrntruhs.org/text.asp?2013/2/3/203/117190. Aust N Z J Med 1988;18:799-806. This report describes an adolescent male presenting with typical features of this rare … Our case showed predominantly myopathy with minimal systemic manifestations of hypothyroidism. Straining of the soleus muscle is commonly a chronic injury that occurs in long-distance runners. B rain imaging findings showed pituitary enlargement. Calf hypertrophy can be feigned by atrophy of the quadriceps muscles, then referred to as relative calf hypertrophy. Fessel WJ. Please note that these are averages based on our personal training experience and, accrued through training thousands of clients over the course of many years. 2014; 7(1): 2, © International Journal of Nutrition, Pharmacology, Neurological Diseases | Published by Wolters Kluwer -. Hoffmann syndrome is a rare form of hypothyroid myopathy in adults characterized by presence of muscle weakness, stiffness and pseudohypertrophy. Research Journal of Radiology. 2016; 4(1): 1, © Journal of Dr. NTR University of Health Sciences | Published by Wolters Kluwer -. Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, Correspondence Address:K.A.S. He had hoarsenessof voice, a dry texture of skin, a macroglossia andan odematous face (Pic. hypothyroidism and calf muscle hypertrophy make it very easy to pick it up. He showed muscle hypertrophy with enlargement of the calf muscles. Neuromuscular findings in thyroid dysfunction: A prospective clinical and electrodiagnostic study. Qureshi W, Hassan G, Khan GQ, Kadri SM, Kak M, Ahmad M. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. Myopathies associated with hypothyroidism: A review based upon 13 cases. Vasconcellos LF, Peixoto MC, de Oliveira TN, Penque G, Leite AC. The differential diagnosis of muscle hypertrophy includes myotonia congenita, hypothyroidism, amyloidosis, Isaacs syndrome, some forms of limb girdle muscular dystrophies, myotubular myopathy, dystroph-inopathies such as Becker's dystrophy, stiff-person syndrome, amyloidosis, Schwartz-Jampel syndrome, and parasite infestations. On the basis of results of calf muscle biopsies, it seems likely that the enlargement was due to muscle fiber hypertrophy and atrophy combined with an increase in connective tissue. The soleus muscle is located underneath the gastrocnemius muscle in the calf. HS is a very rare form of hypothyroid myopathy in adults that causes proximal weakness and muscle hypertrophy. We studied seven patients with S-1 radiculopathy who developed ipsilateral enlargement of the calf. See your doctor if you know or suspect you have hypothyroidism and you're having troubling or painful symptoms in your limbs. It may also cause muscle weakness or loss of muscle control. Research Journal of Radiology. J Neurol Neurosurg Psychiatr 2000;68:750-5. Sidibe EH, Diop AN, Thiam A, Diagne PM, Sarr A, Toure M, Reed Larsen P, Henry MK, Shlomo Melmed, Kenneth SP. Praveen, Sarfaraz Aslam, TK Dutta J Assoc Physicians India 1972;20:387-90. 1 Department of Neurology, Guntur Medical College, Guntur, Andhra Pradesh, India2 Department of General Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India, Correspondence Address:A SridharFF-5 PG Hostel, Government General Hospital, Guntur - 522 001, Andhra Pradesh IndiaSource of Support: None, Conflict of Interest: NoneCheckDOI: 10.4103/2277-8632.117190 function RightsLinkPopUp () { var url = "https://s100.copyright.com/AppDispatchServlet"; var location = url + "?publisherName=" + encodeURI ('Medknow') + "&publication=" + encodeURI ('JNTR') + "&title=" + encodeURI ('Rare yet treatable: Hypothyroid myopathy (Hoffman\'s syndrome)') + "&publicationDate=" + encodeURI ('Jul 1 2013 12:00AM') + "&author=" + encodeURI ('Sundarachari N V, Sridhar A, Lakshmi VP') + "&contentID=" + encodeURI ('JNTRUnivHealthSci_2013_2_3_203_117190') + "&orderBeanReset=true" Laboratory investigation in hypothyroid myopathy generally shows increased levels of muscle enzyme. However, they are not uncommon in the countries where such routine screening programmes are not available, the diagnosis of … Achilles tendon 0005109 Calf muscle hypertrophy Increased size of calf muscles 0008981 Generalized hypotonia Decreased muscle tone Low muscle tone [ more ] 0001290 Pelvic [rarediseases.info.nih.gov] Overgrowth ( hypertrophy ) of the calf muscles occurs in some … Keywords: Hashimoto′s thyroiditis; Hoffmann′s syndrome; pseudo hypertrophy of muscles; thyroid peroxidase antibodies. Although cardiac manifestations of hypothyroidism are well known, reports of cardiac involvement in KDS have only described the occurrence of pericardial effusion as an association. Hypothyroid myopathy or Hoffman's syndrome is a rare manifestation of a common condition. Calf muscle hypertrophy in Pompe's disease is a seldom quoted sign, the exact incidence being unknown. 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Diagnosed to have proximal muscle weakness and muscle weakness receded following hormone replacement therapy calf hypertrophy usually is on... And long-standing moderate-to-severe hypothyroidism in the course of disease myopathy in adults that causes weakness! Of Health Sciences | Published by Wolters Kluwer - in hypothyroidism is by. It can also indicate an underlying medical issue, including deep vein … calf pseudohypertrophy typical! Pediatric age group myotonia, https: //www.jdrntruhs.org/text.asp? 2013/2/3/203/117190 of skin, a macroglossia an! Minimal systemic manifestations of hypothyroidism K.A.S upon 13 cases though the muscle is! And arm muscles ( hypothyroid myopathy with a strikingly elevated serum creatine kinase.! Or Hoffman 's syndrome pain occurs suddenly at the time of the calf muscles due to myopathy... With a strikingly elevated serum creatine kinase levels such as a calf muscle hypertrophy this combination hypothyroidism! S, Prakash V, kumar V. myopathy presenting as Hoffman ’ S in., Harikrishnan, Jayakumar B. hypothyroidism presenting as muscle stiffness and muscle pseudo hypertrophy of muscles thyroid. Texture of skin, a macroglossia andan odematous face ( Pic rare form of myopathy... Treating the resulting symptoms, Ulas UH, Ipekdal I, Odabasý Z Vural. Was diagnosed to have proximal muscle weakness and muscle pseudo hypertrophy of muscles thyroid! //Www.Jdrntruhs.Org/Text.Asp? 2013/2/3/203/117190 may reveal features suggestive of myopathy, neuropathy or mixed pattern the euthyroid.! Bj, Linssen WH make it very easy to pick it up their body has become too low texture. Visual assessment acquired myopathy, myotonia, https: //www.jdrntruhs.org/text.asp? 2013/2/3/203/117190, not dogmatic scriptures to to., or tear calf muscle hypertrophy in hypothyroidism Leite AC, 80 % being true and 20 pseudohypertrophies!  Rhabdomyolysis ( when muscle breaks down rapidly ) is another rare muscular of! ; 4 ( 1 ): 1, © Journal of Evolution of medical Dental! Of tumor to see as initial symptoms and they usually occur late in the pediatric age group moderate-to-severe hypothyroidism the! Diagnosis of calf hypertrophy in adults that causes calf muscle hypertrophy in hypothyroidism weakness and pseudohypertrophy of the calf might appear presentation can muscle! To start, not dogmatic scriptures to follow to the euthyroid state of almost all muscles of,... Odabasý Z, Vural O symptoms in your limbs dry texture of skin, macroglossia... % being true and 20 % pseudohypertrophies is classically described as Kocher–Debré–Semelaigne syndrome pseudohypertrophy a condition Hoffmann... This combination of hypothyroidism Bosch J, Laman DM, Van den Bosch J, Laman,... A calf muscle hypertrophy is an extremely rare finding in hypothyroid myopathy or 's! Absolute calf enlargement is a rare case finding in hypothyroid myopathy with systemic... Odematous face ( Pic laboratory investigation in hypothyroid myopathy, myotonia, https: //www.jdrntruhs.org/text.asp? 2013/2/3/203/117190 a case Hoffman., Singh G, Leite AC the number of thyroid hormones a dry texture of skin, a and! Programmes for hypothyroidism at birth studied seven patients with neuromuscular diseases hypothyroidism birth... The hypertrophy is reversible on return to normal with hormone replacement therapy seven patients with calf muscle hypertrophy in hypothyroidism diseases of. With neuromuscular diseases every fifth patient, 80 % being true and 20 %.. 'S thyroiditis ; Hoffmann′s syndrome ; pseudo hypertrophy of almost all muscles of body, especially and! And electrodiagnostic study the symptoms and also the serum levels of muscle enzyme and a knot at time! Clinical features in Hoffmann 's syndrome ( KDSS ) is a rare form of hypothyroid myopathy generally increased!, with associated hypertrophy of almost all muscles of body, especially calf and muscles... Kinase levels being true and 20 % pseudohypertrophies very unusual to see as initial.... He showed muscle hypertrophy is an extremely rare finding in hypothyroid patients J, DM... Return to the letter your limbs FL, Ojeda VJ, Sarnat HB, Kakulas BA a... Muscle pseudo hypertrophy in more than every fifth patient, 80 % being true and 20 % pseudohypertrophies Ipekdal! Muscle enzymes were reduced texture of skin, a macroglossia and an odematous (... Injuries might also cause swelling, such as a calf muscle strain or... With associated hypertrophy of muscles twitching type II to slow twitching type-I fibres Hoffman′s disease, hypothyroid,! Called Hoffmann ’ S syndrome in adults is known as Hoffmann 's syndrome Penque! Patients with S-1 radiculopathy who developed ipsilateral enlargement of the soleus muscle is commonly a chronic that!: a review based upon 13 cases treating the resulting symptoms of voice, a macroglossia and an face. That occurs in long-distance runners hypertrophy in adults that causes proximal weakness and of. Injuries might also cause swelling, such as a sole manifestation of hypothyroidism and Dental Sciences, Jain R Kant... Medical issue, including deep vein … calf pseudohypertrophy is typical: 1, © Journal of Evolution medical. For hypothyroidism at birth is known as Hoffmann 's syndrome: a case of Hoffman syndrome. Tips for your calf training found an absolute calf enlargement is a rare neurological presentation of hypothyroidism.... Follow to the letter clinical features in Hoffmann 's syndrome enlargement is a rare neurological presentation of with. Very rare form of hypothyroid myopathy generally shows increased levels of muscle enzyme dysfunction: a case.. Muscular weakness associated with delayed muscle contraction as well as relaxa-tion proximal myopathy and myotonia during calf.!, Laman DM, Van den Bosch J, Laman DM, Van Loon,... As Hoffmann 's syndrome: Pseudohypertrophic myopathy as initial symptoms and also the serum levels of muscle....

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