Hoffman syndrome; Rare presentation of hypothyroidism

Hypothyroidism may present with various systemic manifestations including hypothyroid myopathy as a recognized feature. it is characterized by muscle weakness,pain,stiffness,and cramps along with elevated muscle enzymes and thyroid stimulating hormone levels.one of the rare presentations of hypothyroidism is hoffman syndrome characterized by myopathy along with muscle pseudohypertrophy and raised muscle enzymes. we report a case of hoffman syndrome that showed significant clinical and biochemical response to thyroid hormone replacement. this case report highlights the clinical features,diagnostic approach and management of hoffman syndrome. this signifies that early diagnosis and appropriate management improves outcome and prognosis. there have been few such cases reported worldwide and we report this rare case from pakistan.