Covid-19 Research

Short Communication

Endocrinologists - Do You Remember Woltmans Sign? The Delayed Reflexes of Overt Hypothyroidism also occur with T3 Deficiency

Journal of Biomedical Research & Environmental Sciences article abstract with citation details, DOI, publication dates, subject areas, full text links, and references.

View DOI Submit Manuscript

Article Details

Publication record, authors, dates, abstract, and full text access.

Open Access
Article Type Short Communication
Subject Medicine Group
OCLC JBRES Record
TA Welborn*
Issue: Volume5-Issue6
Pages: 580-583
Received: 2024-06-06
Accepted: 2024-06-13
Published: 2024-06-14

Abstract

Woltman’s Sign, the delay in the relaxation phase of the Achilles reflex, has long been recognised as the hallmark of overt hypothyroidism. It is most easily observed with the ankle jerk [1] but delayed relaxation can readily be demonstrated in all deep tendon reflexes including the biceps [2,3]. With hypothyroid patients the relaxation phase can take up to a full second. Numerous devices were devised for timing the ankle jerk [4], including the Burdick photomotogram [3,5,6], but the physical sign is so distinctive that such aids are not required in clinical practice.

FullText HTML FullText PDF DOI: 10.37871/jbres1929 Crossmark

Certificate of Publication

Certificate of Publication

Copyright

© 2024 Welborn TA, et al. Distributed under Creative Commons CC-BY 4.0 Creative CommonsAttribution

How to cite this article

Wang Y, Zheng W. Predictive Pathologic Features of Nodal Metastasis and Tumor Recurrence in HPV-Associated Endocervical Adenocarcinoma. J Biomed Res Environ Sci. 2024 Jun 14; 5(6): 576-582. doi: 10.37871/jbres1928, Article ID: JBRES1928, Available at: https://www.jelsciences.com/articles/jbres1928.pdf

Subject area(s)

Clinical Endocrinology

References

  1. Iwasaki Y, Fukaya K. Woltman's Sign of Hypothyroidism. N Engl J Med. 2018 Oct 4;379(14):e23. doi: 10.1056/NEJMicm1713796. PMID: 30281985.
  2. Sosnay PR, Kim S. Images in clinical medicine. Hypothyroid-induced hyporeflexia. N Engl J Med. 2006 Jun 29;354(26):e27. doi: 10.1056/NEJMicm050622. PMID: 16807409.
  3. Krishnamurthy A, Vishnu VY, Hamide A. Clinical signs in hypothyroidism-myoedema and Woltman sign. QJM. 2018 Mar 1;111(3):193. doi: 10.1093/qjmed/hcx205. PMID: 29194553.
  4. Abraham AS, Atkinson M, Roscoe B. Value of Ankle-jerk Timing in the Assessment of Thyroid Function. Br Med J. 1966 Apr 2;1(5491):830-3. doi: 10.1136/bmj.1.5491.830. PMID: 20790876; PMCID: PMC1844280.
  5. Vulpe M, Martinez A. Rapid Estimation of Thyroid Function by Photomotography. Can Med Assoc J. 1964 Jul 18;91(3):101-5. PMID: 14174525; PMCID: PMC1927274.
  6. Khurana AK, Sinha RS, Ghorai BK, Bihari N. Ankle reflex photomotogram in thyroid dysfunctions. J Assoc Physicians India. 1990 Mar;38(3):201-3. PMID: 2391297.
  7. Ord WM. Address in medicine. Brit Med J. 1884;2:205-211.
  8. Chaney WC. Tendon reflexes in myxedema: A valuable aid in diagnosis. J Amer Med Ass. 1924;82:2013-2016.
  9. Houston CS. The diagnostic importance of the myxoedema reflex (Woltman's sign). Can Med Assoc J. 1958 Jan 15;78(2):108-12. PMID: 13489635; PMCID: PMC1829539.
  10. Wayne EJ. Clinical and metabolic studies in thyroid disease. Br Med J. 1960 Jan 9;1(5166):78-90. doi: 10.1136/bmj.1.5166.78. PMID: 13843211; PMCID: PMC1966196.
  11. Lambert EH, Underdahl LO, Beckett S, Mederos LO. A study of the ankle jerk in myxedema. J Clin Endocrinol Metab. 1951 Oct;11(10):1186-1205. doi: 10.1210/jcem-11-10-1186. PMID: 14873788.
  12. Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, Wayne E, Young JA. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med. 1969 Apr;38(150):255-66. PMID: 4181088.
  13. Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997 Mar;82(3):771-6. doi: 10.1210/jcem.82.3.3810. PMID: 9062480.
  14. Galton VA. The ups and downs of the thyroxine pro-hormone hypothesis. Mol Cell Endocrinol. 2017 Dec 15;458:105-111. doi: 10.1016/j.mce.2017.01.029. Epub 2017 Jan 24. PMID: 28130114.
  15. Burkholder DB, Klaas JP, Kumar N, Boes CJ. The origin of Woltman's sign of myxoedema. J Clin Neurosci. 2013 Sep;20(9):1204-6. doi: 10.1016/j.jocn.2012.09.047. Epub 2013 Mar 19. PMID: 23517675.
  16. Castagna MG, Dentice M, Cantara S, Ambrosio R, Maino F, Porcelli T, Marzocchi C, Garbi C, Pacini F, Salvatore D. DIO2 Thr92Ala Reduces Deiodinase-2 Activity and Serum-T3 Levels in Thyroid-Deficient Patients. J Clin Endocrinol Metab. 2017 May 1;102(5):1623-1630. doi: 10.1210/jc.2016-2587. PMID: 28324063.
  17. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi: 10.4158/EP12280.GL. Erratum in: Endocr Pract. 2013 Jan-Feb;19(1):175. PMID: 23246686.
  18. Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MP. 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyroid J. 2012 Jul;1(2):55-71. doi: 10.1159/000339444. Epub 2012 Jun 13. PMID: 24782999; PMCID: PMC3821467.
  19. Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013 Dec;2(4):215-28. doi: 10.1159/000356507. Epub 2013 Nov 27. PMID: 24783053; PMCID: PMC3923601.
  20. Attanasio R, Žarković M, Papini E, Nagy EV, Negro R, Perros P, Akarsu E, Alevizaki M, Ayvaz G, Bednarczuk T, Beleslin BN, Berta E, Bodor M, Borissova AM, Boyanov M, Buffet C, Burlacu MC, Ćirić J, Díez JJ, Dobnig H, Fadeyev V, Field BCT, Fliers E, Führer-Sakel D, Galofré JC, Hakala T, Jiskra J, Kopp PA, Krebs M, Kršek M, Kužma M, Lantz M, Lazúrová I, Leenhardt L, Luchytskiy V, Marques Puga F, McGowan A, Metso S, Moran C, Morgunova T, Niculescu DA, Perić B, Planck T, Poiana C, Robenshtok E, Rosselet PO, Ruchala M, Ryom Riis K, Shepelkevich A, Tronko MD, Unuane D, Vardarli I, Visser WE, Vryonidou A, Younes YR, Hegedüs L. Patients' Persistent Symptoms, Clinician Demographics, and Geo-Economic Factors Are Associated with Choice of Therapy for Hypothyroidism by European Thyroid Specialists: The "THESIS" Collaboration. Thyroid. 2024 Apr;34(4):429-441. doi: 10.1089/thy.2023.0580. Epub 2024 Mar 22. PMID: 38368541.
  21. Welborn TA. Practice guidelines for hypothyroidism in adults: clinical issues and the controversy about combination therapy. Endocr Pract. 2013 Nov-Dec;19(6):1062-4. PMID: 24280517.
  22. Welborn TA. More trials for the unhappy hypothyroid patient on thyroxine: a clinician's perspective. Trends Endocrinol Metab. 2022 Aug;33(8):536-538. doi: 10.1016/j.tem.2022.04.010. Epub 2022 May 23. PMID: 35618561.
  23. Lin-Wei O, Xian LLS, Shen VTW, Chuan CY, Halim SA, Ghani ARI, Idris Z, Abdullah JM. Deep Tendon Reflex: The Tools and Techniques. What Surgical Neurology Residents Should Know. Malays J Med Sci. 2021 Apr;28(2):48-62. doi: 10.21315/mjms2021.28.2.5. Epub 2021 Apr 21. PMID: 33958960; PMCID: PMC8075597.
  24. Schwartz RS, Morris JG, Crimmins D, Wilson A, Fahey P, Reid S, Joffe R. A comparison of two methods of eliciting the ankle jerk. Aust N Z J Med. 1990 Apr;20(2):116-9. doi: 10.1111/j.1445-5994.1990.tb01286.x. PMID: 2344316.
  25. O'Keeffe ST, Smith T, Valacio R, Jack CI, Playfer JR, Lye M. A comparison of two techniques for ankle jerk assessment in elderly subjects. Lancet. 1994 Dec 10;344(8937):1619-20. doi: 10.1016/s0140-6736(94)90411-1. PMID: 7695707.
Publish with JBRES — Peer-reviewed, multidisciplinary Open Access with rapid review, DOI, and global visibility.
Double-Blind CrossRef DOI Discoverable
Submit Manuscript Membership