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Case Reports
. 2023 Oct 31;17(1):473.
doi: 10.1186/s13256-023-04184-6.

Hoffmann's syndrome in the differential work-up of myopathic complaints: a case report

Sabine Winter  1 , Bianka Heiling  1   2 , Niklas Eckardt  3 , Christof Kloos  4 , Hubertus Axer  5
Affiliations
Case Reports

Hoffmann's syndrome in the differential work-up of myopathic complaints: a case report

Sabine Winter et al. J Med Case Rep. .

Abstract

Background: Hoffmann's syndrome is a rare form of hypothyroid myopathy in adults, which is mainly characterized by muscular weakness and muscular pseudohypertrophy.

Case presentation: We report about a 61-year-old Western European man with myalgia, myxedema and pseudohypertrophy of the calf muscles. Laboratory tests revealed significantly elevated thyroid stimulating hormone (TSH) and creatine kinase (CK). Muscle MRI showed muscular hypertrophy of the lower limbs, but no signs of myositis or myopathy (no gadolinium enhancement, no edema, no fatty degeneration). In addition, electromyography (EMG) detected spontaneous activity. After the beginning of thyroxin-therapy it took six months until the muscle weakness improved and the myalgia regressed.

Conclusions: Here, we focus on diagnostic routines and typical findings to differentiate Hoffmann's syndrome from other myopathies. Clinical hallmarks of Hoffmann's syndrome are pseudohypertrophy and weakness of the calf muscles in combination with elevated CK and elevated TSH. EMG is well suited to detect the involvement of the muscles and muscle MRI helps to differentiate it from other myopathies. Hoffmann's syndrome is a rare myopathy due to hypothyroidism and plays a role in the differential diagnosis of myopathic complaints even if hypothyroidism has not been detected before.

Keywords: EMG; Hoffmann’s syndrome; Hypothyroidism; MRI; Muscle biopsy; Myopathy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Calf muscles of the patient. A Photograph. B Muscle MRI. C and D Muscle ultrasound
See this image and copyright information in PMC

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