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Hoffman’s Syndrome, Hypothyroidism, and Muscle Weakness

Learn your potential risk and connection with experiencing muscle weakness and Hoffman’s Syndrome.
Hoffman’s Syndrome, Hypothyroidism, and Muscle Weakness
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Muscle weakness –  known as hypothyroid myopathy – is a common symptom experienced by people with hypothyroidism. In some cases, the muscle weakness develops into a condition called Hoffman’s syndrome. Ahead, a look at how these conditions are related can help you better manage your symptoms and seek appropriate treatment.

What is hypothyroid myopathy? 

Hypothyroid myopathy is the medical term for muscle weakness and fatigue caused by an underactive thyroid gland. The thyroid gland, located in the neck, produces hormones that regulate the body’s metabolism, including the metabolism that powers your muscles. When the thyroid gland doesn’t produce enough hormones, it can lead to various symptoms, including muscle weakness and difficulty with tasks that require muscle strength. These hormones are crucial to muscle function, including muscle contraction and relaxation. Hypothyroid myopathy affects both men and women, although it is more common in women.

Duyff RF, Van den Bosch J, Laman DM, et alNeuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery & Psychiatry 2000;68:750-755.

What is Hoffman’s syndrome?

Hoffmann’s syndrome is a form of hypothyroid myopathy and a relatively rare neurological condition affecting the body’s muscles and nerves, particularly in the hands and arms. It’s named after the French neurologist Johann Hoffman, who first identified and described the syndrome. Hoffman’s syndrome is also known by several other names, including Hoffman’s disease, acroparesthesia, and palmar reflex myoclonus.

Causes of Hoffman’s syndrome

Hoffman’s syndrome is caused by a dysfunction in the mitochondria, which are the powerhouses of the cells that produce energy. This dysfunction leads to a lack of energy production, resulting in muscle weakness and fatigue.

One possible cause of Hoffman’s syndrome is genetics. Studies have shown that there may be a genetic predisposition to this condition, meaning it can be passed down from parents to their children. This finding suggests that specific genetic mutations or variations may increase the risk of developing Hoffman’s syndrome. However, in some cases, it can occur spontaneously without any familial history. Hoffman’s syndrome is also believed to be related to autoimmune hypothyroidism, which also has a genetic component.

Another potential cause of Hoffman’s syndrome is neurological damage or injury. Trauma to the spinal cord or brain can disrupt the nervous system’s normal functioning, leading to abnormal muscle spasms and twitches. This damage could result from accidents, injuries, or medical conditions such as tumors or infections.

Additionally, some medications and drugs have been linked to the development of muscle spasms similar to those seen in Hoffman’s syndrome. Certain medications used to treat psychiatric disorders, such as antipsychotics or antidepressants, have been associated with the onset of this condition. Drugs such as cocaine or amphetamines can also affect the nervous system and potentially trigger muscle spasms.

Several medical conditions have also been linked to the development of Hoffman’s syndrome. Neurological disorders such as multiple sclerosis or brain tumors can disrupt the normal communication between the nerves and muscles, leading to abnormal muscle movements. Conditions such as hypocalcemia, which affects the hormonal or electrolyte balance in the body, can also contribute to the development of muscle spasms.

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Symptoms of Hoffman’s syndrome

The symptoms of Hoffman’s syndrome typically appear in early adulthood, although they can sometimes show up later in life. In Hoffman’s syndrome, muscle weakness is predominantly seen in the proximal muscles – the muscles nearest to the trunk of the body. This weakness can affect the ability to perform basic daily activities such as climbing stairs, getting up from a seated position, or even lifting objects.

One of the primary symptoms of Hoffman’s syndrome is muscle weakness. This weakness can affect various body parts, including the arms, legs, and sometimes even the facial muscles. Individuals with Hoffman’s syndrome often struggle with tasks that require strength, such as lifting heavy objects or participating in sports activities. The weakness can gradually progress over time, affecting daily activities and mobility.

In addition to muscle weakness, individuals with Hoffman’s syndrome may also experience muscle stiffness or spasticity. This stiffness can occur in different muscle groups, leading to movement, coordination, and balance difficulties. They may have a decreased range of motion, making it challenging to perform specific tasks or even simple activities like walking or getting out of a chair.

Another common symptom of Hoffman’s syndrome is muscle twitching, also known as fasciculations. These involuntary muscle twitches can occur randomly or be triggered by specific actions or movements. Although muscle twitching is not usually painful, it can be uncomfortable and may interfere with everyday activities.

Individuals with this condition may also experience sensory changes. They might have decreased sensation or numbness in certain areas of their body. It can affect different senses, such as touch, temperature, or even proprioception (the sense of body position). These sensory changes can further impact their daily functioning and coordination.

In some cases, individuals with Hoffman’s syndrome may have associated symptoms like fatigue, tingling, numbness, pain in hands and feet, muscle cramps, or tremors. Fatigue can be debilitating, causing a significant decrease in energy levels and overall physical endurance. Muscle cramps and pain can also interfere with daily activities and cause discomfort.

It’s important to note that the severity and specific symptoms of Hoffman’s syndrome can vary from person to person. Some individuals may have milder symptoms that only slightly impact their daily lives, while others may experience more significant challenges.

The link between Hoffman’s syndrome and hypothyroidism

Thyroid hormones are responsible for the normal growth and development of muscle tissue, as well as maintaining their strength and coordination. When thyroid hormone levels are low, it can lead to hypothyroid myopathy – muscle weakness and fatigue – and, in more severe cases, Hoffman’s syndrome.

How hypothyroidism leads to Hoffman’s syndrome is not fully understood. However, research has shown, specifically, that treatment of hypothyroidism can improve or even resolve Hoffman’s syndrome. One study reported that Hoffmann’s syndrome is one of the rare forms of myopathy that completely reverses with timely treatment and, therefore, has a good outcome. Another study reported on a patient with Hoffman’s syndrome whose muscle weakness fully resolved after thyroid hormone replacement treatment

How is Hoffman’s syndrome diagnosed?

Several approaches and clinical guidelines are used to diagnose Hoffman’s syndrome.

Medical history and physical exam: A healthcare provider will begin by taking a detailed medical history, including any symptoms you are experiencing, their severity, and when they first appeared. They will also perform a physical examination to assess your reflexes, muscle strength, and coordination.

Thyroid panel: In patients who have not yet been diagnosed with hypothyroidism, a complete thyroid blood test panel will usually be done to assess thyroid function. For patients already being treated, a thyroid panel can help determine if the condition is being optimally treated.

Other blood tests: Blood tests may be ordered to rule out other conditions that could be causing similar symptoms. These tests may include a complete blood count (CBC), metabolic panel, and tests to check for specific markers of inflammation or autoimmune disorders.

Hoffman’s reflex test: This test involves applying brief, firm downward pressure to the middle finger or thumb, causing the hand and fingers to twitch or jerk involuntarily. This reflex is known as the Hoffman reflex and is a characteristic feature of Hoffman’s syndrome. A positive Hoffman’s reflex indicates the presence of the condition.

Babinski test: This test is sometimes used in addition to the Hoffman’s reflex test. The Babinski test involves gently stroking the sole of the foot, from the heel to the big toe. In individuals with Hoffman’s syndrome, there may be an abnormal response known as an upward plantar reflex, where the big toe extends upward rather than curling downward. This abnormal response is a sign of neurological dysfunction and can support the diagnosis of Hoffman’s syndrome.

Nerve conduction studies (NCS): NCS involves using small electrodes placed on the skin to measure the speed at which electrical impulses travel along the nerves. This test helps determine if there is nerve damage or dysfunction, which could indicate Hoffman’s syndrome.

Electromyography (EMG): EMG measures the electrical activity of muscles at rest and during contraction. It involves the insertion of a fine needle electrode into the muscle tissue to assess its function. EMG can help identify muscle abnormalities and determine if the symptoms are related to muscle dysfunction.

Genetic testing: Hoffman’s syndrome has been associated with specific genetic mutations. In some cases, genetic testing may be performed to identify these mutations and confirm the diagnosis.

It is important to note that diagnosing Hoffman’s syndrome can be challenging due to its rarity and similarity to other neurological conditions. Therefore, consulting with a healthcare professional specializing in neurology or movement disorders is crucial. They will have the expertise to differentiate Hoffman’s syndrome from other conditions and implement the appropriate tests and guidelines for an accurate diagnosis. 

Treatment for Hoffman’s syndrome

The good news is that Hoffman’s syndrome is considered reversible! Here are the various treatment options available for individuals with Hoffman’s syndrome and hypothyroidism.

Thyroid hormone replacement medication

In Hoffman’s syndrome, the body’s tissues do not respond to thyroid hormone effectively. Therefore, treatment aims to provide the body with an increased supply of thyroid hormones to compensate for the resistance. Thyroid hormone replacement therapy replaces the inadequate production by the thyroid gland. Thyroid medication works by supplementing the body with an artificial source of thyroid hormone, bypassing the body’s resistance and helping to alleviate symptoms, including muscle weakness.

When starting thyroid hormone replacement medication for Hoffman’s syndrome, working closely with a healthcare professional specializing in hypothyroidism is essential. They will be able to determine the appropriate medication dosage based on your individual needs and monitor treatment progress over time.

Regular monitoring of thyroid hormone levels through blood tests is essential to ensure that the medication dosage is adequate. These tests measure levels of thyroid-stimulating hormone (TSH), free thyroxine (T4), and free triiodothyronine (T3) in the blood, which can provide valuable insight into your thyroid function.

It is important to note that thyroid hormone replacement medication is not a cure for Hoffman’s syndrome. Thyroid treatment helps manage the symptoms associated with the condition and improve overall well-being. The thyroid medication dosage may need to be adjusted periodically based on symptoms and blood test results.

Physical therapy and exercise

Physical therapy is also an important part of the treatment plan for muscle weakness due to Hoffman’s syndrome and hypothyroid myopathy. A physical therapist can develop a customized exercise program to help improve mobility, strength, and coordination in the affected hand and fingers. These exercises may include stretching, strengthening, and range of motion exercises, as well as techniques to improve fine motor skills. Physical therapy can also help individuals learn adaptive techniques and strategies to manage their symptoms in daily activities.

Botulinum toxin injections 

One of the most common treatment approaches for Hoffman’s syndrome is the use of botulinum toxin injections. Botulinum toxin, commonly known as Botox, is a medication that can temporarily paralyze the muscles and reduce muscle contractions. Injecting Botox into the affected hand and fingers can help alleviate involuntary movements and provide relief for individuals with Hoffman’s syndrome. The effects of Botox injections typically last for a few months, so that regular follow-up treatments may be necessary.

Oral medications

In some cases, oral medications may be prescribed to help manage the symptoms of Hoffman’s syndrome. Prescription muscle relaxants or anti-seizure medications can be used to reduce muscle contractions and relieve pain or discomfort. However, it is important to note that medication effectiveness may vary from person to person, and there may be potential side effects to consider.


In severe cases of Hoffman’s syndrome where conservative treatments have not been effective, surgery may be considered as a treatment option. Surgical procedures, such as selective denervation, aim to selectively weaken or remove some of the overactive muscles to reduce involuntary movements. However, surgery is generally considered a last resort and is only recommended when other treatment options have been exhausted.

Healthy diet

It is also essential for individuals with Hoffman’s syndrome and hypothyroidism to adopt a healthy, well-balanced diet rich in essential nutrients and vitamins. Eating a well-balanced diet is crucial for thyroid function. Include foods high in iodine, such as seaweed, seafood, and dairy products. Selenium-rich foods like Brazil nuts, mushrooms, and sunflower seeds can also support healthy thyroid function. Avoid or limit processed foods, refined sugars, and excessive caffeine, as they can negatively affect thyroid function and increase inflammation.

Physical activity 

Regular physical activity can help relieve thyroid symptoms, improve well-being, and increase flexibility, balance, and muscle stiffness. Both yoga and Tai Chi are gentle forms of exercise that incorporate slow movements, stretching, and breathing techniques. These practices are especially recommended for patients with Hoffman’s syndrome. Additionally, they promote relaxation, reduce stress levels, and enhance overall physical and mental well-being.

Sleep and stress management

Lack of sleep and chronic stress can contribute to thyroid dysfunction and symptoms in Hoffman’s syndrome. Aim for 7 to 9 hours of quality sleep per night. And incorporate stress-management techniques into your daily routine, such as meditation, deep breathing exercises, or yoga. Engaging in activities you enjoy and spending time with loved ones can also help reduce stress levels.


Certain dietary supplements, such as omega-3 fatty acids, vitamin D, and selenium, may benefit people with Hoffman’s syndrome and hypothyroid myopathy. These supplements can help support muscle function, reduce inflammation, and improve overall health. However, consulting with a healthcare professional before starting any supplementation regimen is important.

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Acupuncture sessions can help reduce Hoffman’s syndrome and hypothyroid myopathy symptoms. Acupuncture, an ancient Chinese practice, involves the insertion of thin needles into specific points on the body to stimulate energy flow and promote healing. It has shown promising results in managing muscle pain and fatigue and improving overall well-being. Some studies also suggest that acupuncture may improve thyroid function and hormone levels in individuals with hypothyroidism. 

Massage therapy

Massage therapy can be beneficial in managing muscle stiffness, pain, and tension associated with Hoffman’s syndrome and hypothyroidism. Massage techniques, such as deep tissue and Swedish massage, help increase blood circulation, reduce muscle tightness, and promote relaxation. Regular sessions can provide relief and improve overall muscle function.

A note from Paloma

Muscle weakness is a common symptom experienced by individuals with hypothyroidism and, in some cases, can be evidence of Hoffman’s syndrome. Understanding the relationship between these two conditions is essential in managing symptoms effectively. With a combination of thyroid hormone replacement therapy, other medical treatments when needed, physical activity, and a healthy lifestyle, most people can minimize muscle weakness, reverse Hoffman’s syndrome, and lead a more active, pain-free life.

Because thyroid treatment is the first step in effectively treating hypothyroid myopathy and Hoffman’s syndrome, it’s important to work with healthcare providers specializing in diagnosing, optimally treating, and holistically managing hypothyroidism. Paloma’s network of top thyroid care practitioners is an excellent choice for anyone who wants comprehensive, patient-oriented thyroid treatment. Learn more about becoming a Paloma member now

It’s also crucial to keep up with regular thyroid testing to ensure optimal thyroid function. The affordable Paloma Complete Thyroid Test Kit makes regularly testing your thyroid easy and convenient. The kit measures your TSH, Free T4, Free T3, and TPO antibodies, and you can add on a Reverse T3 and Vitamin D test.

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Vasconcellos LF, Peixoto MC, de Oliveira TN, Penque G, Leite AC. Hoffman’s syndrome: pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report. Arq Neuropsiquiatr. 2003 Sep;61(3B):851-4. doi: 10.1590/s0004-282x2003000500027. Epub 2003 Oct 28. PMID: 14595495.

Sharma, Deepali; Arora, Aanchal; Mudalagiri, Manasa; Porwal, Yogesh Chandra. Hoffmann syndrome: A rare and reversible case of hypothyroid myopathy. Thyroid Research and Practice 16(1):p 42-44, Jan–Apr 2019. | DOI: 10.4103/trp.trp_33_18

Mangaraj S, Sethy G. Hoffman’s syndrome - A rare facet of hypothyroid myopathy. J Neurosci Rural Pract. 2014 Oct;5(4):447-8. doi: 10.4103/0976-3147.140025. PMID: 25288869; PMCID: PMC4173264.

Duyff RF, Van den Bosch J, Laman DM, et alNeuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery & Psychiatry 2000;68:750-755.


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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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