Woltman's sign of hypothyroidism- ...At the time of presentation, a physical examination was notable for the presence of a diffusely enlarged thyroid gland and delayed relaxation of the ankle jerk reflex (Panel A and video) (see source for video)...Woltman’s sign, which refers to the delayed relaxation phase of a deep-tendon reflex, is a neurologic manifestation of hypothyroidism. This delayed relaxation can also be associated with pregnancy, anorexia nervosa, diabetes mellitus, and advanced age. The patient received thyroid hormone replacement therapy with levothyroxine for primary hypothyroidism. One month later, the serum free thyroxine level had increased to 1.23 ng per deciliter (16 pmol per liter), the serum thyrotropin level was 20.5 mIU per liter, and the patient’s ankle jerk relaxation had normalized (Panel B and video)... #clinical #photo #NEJM #Woltmans #hypothyroidism #ankle #jerk #reflex