Bosphorus Med J. 2022; 9(4): 276-278 | DOI: 10.14744/bmj.2022.09226

Drug Related Thyroid Myopathy: Hoffmann’s Syndrome Case Report

Cansu Gülcihan Türkok, Okan Aksahin, Ceyda Dogan, Mehmet Güney Þenol, Mehmet Fatih Özdað
Sultan Abdülhamit Han Eðitim ve Araþtýrma Hastanesi Nöroloji Bölümü, Ýstanbul, Türkiye

Hipotiroidi, doku düzeyinde tiroid hormonu yetersizliði veya nadiren etkisizliði sonucu ortaya çýkan, metabolik yavaþlama ile giden bir hastalýktýr. Hipotiroidi miyopatisi bu endokrin hastalýðýn seyri süresince geliþen bir kas hastalýðýdýr. Bu hastalýk yaygýn kas güçsüzlüðü, kas aðrýlarý ve kramplar ile karakterize olmaktadýr. Bu olguda hipotiroidi miyopatisine baðlý geliþen Hoffmann sendromlu bir hastanýn klinik, laboratuvar bulgularý ve düzenlenen hormon replasman tedavisine verdiði iyi yanýt aktarýlmaktadýr. Ýki yýl önce Graves hastalýðý tanýsý alan 22 yaþýnda erkek hasta, 1,5 yýl önce tirotoksikoz nedeniyle bilateral tiroidektomi operasyonu geçirmiþtir. Tarafýmýza baþvurusunda 150 mcg/gün L-tiroksin kullanmaktaydý. Hastanýn öyküsünde iki ay önce vücut geliþtirme amacýyla doktor tavsiyesi olmadan kendisine intramusküler hormon tedavisi uygulandýðý öðrenildi. Ýki ay önceki metil-testosteron kullanýmýndan üç hafta sonra baþlayan ve bir aydýr artarak devam etmekte olan yaygýn kas kramplarý, güçsüzlük, kas aðrýsý þikayetleri ile tarafýmýza baþvurdu. Laboratuvar bulgularýnda sT3, sT4 düzeyi düþük, tiroid stimülan hormon ve kreatinin kinaz düzeyi yüksek saptandý. Proksimal kaslarda belirgin hipertrofik görünümü olan hastaya Hoffmann sendromu tanýsý koyularak levotiroksin tedavisi 250 mcg/gün olarak düzenlendi. Hastanýn takipleri sýrasýnda klinik ve laboratuvar bulgularýnda tam düzelme gözlenmiþ olup takip ve tedavisi devam etmektedir.

Anahtar Kelimeler: Hoffmann sendromu, hipotiroidi, miyopati, metiltestosteron.

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Ýlaç Ýliþkili Tiroid Miyopati: Hoffmann Sendromu Olgu Sunumu

Cansu Gülcihan Türkok, Okan Aksahin, Ceyda Dogan, Mehmet Güney Þenol, Mehmet Fatih Özdað
Department of Neurology, Sultan Abdülhamit Han Training and Research Hospital, Ýstanbul, Türkiye

Hypothyroid myopathy is a muscle disease with endocrine disease related abnormal hormone levels and Hoffman’s syndrome is a rare form of hypothyroid myopathy. The disease commonly involves muscle weakness, muscle pain, and cramps. In this case, we talked about the clinical and laboratory findings and his good response to hormone replacement therapy of a patient with Hoffmann syndrome who developed due to hypothyroidism myopathy. A 22-year-old male patient, diagnosed with graves 2 years ago, after that he had a bilateral thyroidectomy surgery 1.5 years ago, has been still using L-thyroxine 150 mcg/day. In the patient’s history, it was learned that intramuscular hormone therapy was administered to his 2 months ago for bodybuilding purposes without the doctor’s advice. When he applied to us, he was suffering from widespread muscle cramps, muscle pain, and weakness for 1 month. It is learned that he had methyltestosterone injection 2 months ago and after 3 weeks of injections, symptoms had been showed up. In laboratory findings, while sT3, sT4 levels were low, TSH and CK levels were high. On examinations, muscle hypertrophy was more specifically seen on proximal muscles. He is diagnosed with Hoffmann’s Syndrome and L thyroxine treatment has rearranged from 150 mcg/day to 250 mcg/day. During the follow-up of the patient, complete improvement was observed in the clinical and laboratory findings and the follow-up, and treatment continues.

Keywords: Hoffman’s syndrome, hypothyroid, methyl testosterone, myopathy.

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ATIF KOPYALA