Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

Citations

Citations to this article as recorded by  

• Hoffmann’s syndrome in the differential work-up of myopathic complaints: a case report
  Sabine Winter, Bianka Heiling, Niklas Eckardt, Christof Kloos, Hubertus Axer
  Journal of Medical Case Reports.2023;[Epub]     CrossRef
• Hypothyroidism: A Peculiar Presentation
  Rita V Nogueira, Rui Lima, Carina Parente, Pedro Liberal, Lucia Santos
  Cureus.2023;[Epub]     CrossRef
• Hoffman's syndrome as the presenting manifestation of non-primary hypothyroidism in a case of Prader-Willi Syndrome
  R. Ghosh, A. Ray, D. Roy, J. Benito-Leon
  Neurología.2022; 37(9): 824.     CrossRef
• Hoffman's syndrome as the presenting manifestation of non-primary hypothyroidism in a case of Prader-Willi Syndrome
  R. Ghosh, A. Ray, D. Roy, J. Benito-Leon
  Neurología (English Edition).2022; 37(9): 824.     CrossRef
• Hoffmann’s syndrome necessitating forearm fasciotomy: a case report
  Erling Aarsæther, Ragnar Joakimsen, Hanne Halvorsen, Trude Sildnes, Olav Sivertsen, Jan Due
  Journal of Medical Case Reports.2020;[Epub]     CrossRef
• Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature
  Alessandro Sindoni, Carmelo Rodolico, Maria Angela Pappalardo, Simona Portaro, Salvatore Benvenga
  Reviews in Endocrine and Metabolic Disorders.2016; 17(4): 499.     CrossRef

A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

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• Brown tumor of the knee as the first presentation of primary hyperparathyroidism caused by parathyroid adenoma: A case report
  Vaishnavi C Tapadia, Romana Riyaz, Abhigan Babu Shrestha, Javeed Akhtar Ankolvi
  Radiology Case Reports.2023; 18(5): 1852.     CrossRef
• Brown tumors in nuclear medicine: a systematic review
  Nicolas Jacquet-Francillon, Nathalie Prevot
  Annals of Nuclear Medicine.2023; 37(5): 255.     CrossRef
•  Misdiagnosis of brown tumour caused by primary hyperparathyroidism: a case report with literature review
  Yanchun Zhong, Yuxi Huang, Jiaquan Luo, Yongjun Ye
  BMC Endocrine Disorders.2022;[Epub]     CrossRef
• Gnathic Bones and Hyperparathyroidism: A Review on the Metabolic Bony Changes Affecting the Mandible and Maxilla in case of Hyperparathyroidism
  Hazim Mahmoud Ibrahem
  Advances in Medicine.2020; 2020: 1.     CrossRef

Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alternatively, it may only represent the delayed recognition of a rare change in the natural history of Graves' disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves' disease.

Citations

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• Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism
  Muhammet C. Bilginer, Didem Ozdemir, Fatma N. C. Seyrek, Nilufer Yildirim, Aylin K. Yazgan, Mehmet Kilic, Reyhan Ersoy, Bekir Cakir
  Diagnostic Cytopathology.2020; 48(1): 3.     CrossRef
• Papillary thyroid carcinoma in cervical lymph nodes with vanished thyroid gland after ablation of Graves’ disease by radioactive iodine
  O Hamdy, S Raafat, GA Saleh, K Atallah, Mahmoud M Saleh, AM Shebl, MA Hegazy
  The Annals of The Royal College of Surgeons of England.2019; 101(5): e122.     CrossRef
• Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
  Won-Young Lee
  Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef