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Woltman's sign (also called Woltman's sign of hypothyroidism or, in older references, myxedema reflex [1]) is a delayed relaxation phase of an elicited deep tendon reflex, usually tested in the Achilles tendon of the patient. Woltman's sign is named for Henry Woltman, an American neurologist. [2]
Signs and symptoms include exercise intolerance, muscle fatigue, muscle cramps, myalgia, delayed muscle relaxation (pseudomyotonia), proximal muscle weakness, delayed deep tendon reflexes (hyporeflexia) especially of the ankles, and a pseudoathletic appearance of hypertrophic calf muscles.
Myxedema psychosis is a relatively uncommon consequence of hypothyroidism, such as in Hashimoto's thyroiditis or in patients who have had the thyroid surgically removed and are not taking thyroxine. A chronically under-active thyroid can lead to slowly progressive dementia , delirium , and in extreme cases to hallucinations , coma , or ...
The Achilles reflex checks if the S 1 and S 2 [3] nerve roots are intact and could be indicative of sciatic nerve pathology. It is classically delayed in hypothyroidism. This reflex is usually absent in disk herniations at the L 5 —S 1 level. A reduction in the ankle jerk reflex may also be indicative of peripheral neuropathy.
The term "deep tendon reflex", if it refers to the muscle stretch reflex, is a misnomer. "Tendons have little to do with the response, other than being responsible for mechanically transmitting the sudden stretch from the reflex hammer to the muscle spindle.
Cases of severe muscle atrophy or destruction may render the muscle too weak to show any reflex and should not be confused with a neuronal cause. [citation needed] Hyporeflexia may have other causes, including hypothyroidism, electrolyte imbalance (e.g., excess magnesium), and drug use (e.g, depressants). [1]
Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. [1] [2] [3] A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction, or stroke) precipitates the myxedema coma state, usually in the elderly.
Hoffmann's reflex is a deep tendon reflex (spindle fibre) with a monosynaptic reflex pathway in Rexed lamina IX of the spinal cord, normally fully inhibited by descending input. On the other hand, the plantar reflex is more complicated and not a deep tendon reflex, and its pathway is both more complicated and not fully understood. [8]