Teaching video neuroimages: involuntary muscle contractions in Hoffman syndrome.

Caitlin Loomis, MD Shawn J. Bird, MD Joshua M. Levine, MD Hoffman syndrome is a rare constellation of features that occurs in severely hypothyroid adults. It is characterized by muscle hypertrophy, weakness, stiffness, and slowness of movement with or without muscle cramps.1 Elevation of creatine kinase is common, but does not correlate with disease severity.2 A 50-year-old man from Ghana presented with painful cramps and involuntary contractions of his shoulders, arms, and legs (see video on the Neurology Web site at www.neurology.org). He reported difficulty with sustained muscle activity and fatigue. Laboratory data were significant for thyroidstimulating hormone of 108 IU/mL and creatine kinase of 6,072 U/L. He was diagnosed with severe hypothyroidism presenting as Hoffman syndrome. His symptoms resolved with levothyroxine.