People with hypothyroidism can have delayed ankle reflexes when someone taps the Achilles tendon. This is known as Woltman’s sign, and doctors can use it to help make a diagnosis.
The thyroid gland plays a role in various physiological processes, including the activity of the nervous system. When underactive, it may affect reflexes.
Woltman’s sign is characterized by a slow return to the resting position after a reflex contraction. It is particularly noticeable in the ankle.
This article explores the ankle reflex in hypothyroidism, its causes, and when a person should contact a doctor.
The hypothyroid reflex sign, or Woltman’s sign, is a potential sign of hypothyroidism that clinicians may observe during a neurological examination.
When a doctor tests a reflex, there is usually a very brief contraction of a tendon and then relaxation. Woltman’s sign describes a delayed relaxation phase after the contraction of a tendon in the ankle. Instead of the usual quick return to the resting position, the foot moves more slowly.
Hypothyroidism affects reflexes because thyroid hormones
When thyroid hormone levels are low, as they are in hypothyroidism, these processes slow down. This results in muscles being less responsive, leading to slower reflexes. Hypothyroidism can also damage the nerves that control muscle movements, further affecting reflexes.
Testing for Woltman’s sign involves assessing the deep tendon reflexes, mainly the Achilles reflex. The procedure is as follows:
- Have the individual lie down or sit with their legs dangling freely off of an examination table.
- Locate the Achilles tendon at the back of the ankle.
- Tap the Achilles tendon briskly using a reflex hammer.
- Observe the response.
The foot will usually jerk downward and quickly return to its resting position. However, if Woltman’s sign is present, the downward movement occurs, followed by a slower, delayed return to the resting position.
Woltman’s sign alone is not necessarily an indication of hypothyroidism. If a person has this sign, they should speak with a doctor for a diagnosis.
Woltman’s sign often indicates hypothyroidism, but other conditions can also cause similar changes to reflexes. These include:
- Advanced age: As people age, the nervous system undergoes changes that can slow reflex responses. Although this slowing is typically less pronounced than in hypothyroidism, it can still result in a delayed relaxation phase of the reflexes.
- Pregnancy: Hormonal fluctuations during pregnancy can affect neuromuscular function, sometimes leading to temporary reflex changes.
- Anorexia nervosa: Severe nutritional deficiencies that occur due to anorexia nervosa can lead to multiple systemic effects, including alterations in muscle and nerve function.
- Diabetes mellitus: Diabetic neuropathy is a complication of diabetes and can damage peripheral nerves, leading to slowed or diminished reflexes.
- Sarcoidosis: This inflammatory disease can affect various parts of the body, including the nervous system. When sarcoidosis involves the nerves, it can cause neuropathy, which might present with reflex abnormalities that resemble Woltman’s sign.
- Pernicious anemia: The vitamin B12 deficiency that pernicious anemia causes can lead to neurological symptoms, including peripheral neuropathy. This condition can lead to altered reflexes.
- Drug and alcohol use: Long-term use of certain drugs and alcohol can lead to neuropathy, which affects the nerves controlling muscle reflexes.
Rarely, individuals with hypothyroidism may have exaggerated reflexes, or hyperreflexia, rather than delayed reflexes. The reason for this unusual response is not fully understood.
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In some instances of hypothyroidism, particularly when the condition is caused by issues in the brain or pituitary gland, levels of TRH can become high. Experts link this increase in TRH to the development of hyperreflexia and sudden muscle jerks.
Hyperreflexia may also occur in people with Hashimoto encephalopathy (HE). HE is a rare neurological condition that may develop due to Hashimoto thyroiditis, an autoimmune form of hypothyroidism. However, scientists are still researching if there is any connection.
In HE, the brain does not work as it should, affecting attention, thinking, consciousness, and the sleep cycle. A person may also feel jittery, confused, or have changes to their ability to walk or talk.
In these cases, hyperreflexia is likely a result of inflammation in the brain and not the thyroid. Most people with hypothyroidism, including those with Hashimoto thyroiditis, will not experience HE.
Another possibility is that people taking levothyroxine for hypothyroidism could experience side effects. Taking too much levothyroxine can cause a person to have the symptoms of an overactive thyroid, which can include hyperactive reflexes.
If an individual experiences symptoms suggestive of hypothyroidism, such as fatigue, unexpected weight gain, cold intolerance, or changes in reflexes, they could talk with a healthcare professional.
Hypothyroidism is treatable with medication. Early detection and treatment can prevent complications and improve quality of life.
If someone already diagnosed with hypothyroidism notices new or worsening symptoms, they should seek medical advice to ensure their treatment plan is still appropriate.
A delayed ankle reflex can be a symptom of hypothyroidism. Clinicians refer to this as Woltman’s sign, and it is a valuable diagnostic marker.
Woltman’s sign occurs because hypothyroidism slows down the metabolic processes necessary for muscle and nerve function. Reduced thyroid hormone levels lead to impaired nerve and muscle activity, causing muscles to relax more slowly after contracting. This delayed response is particularly noticeable in the ankle reflex.
However, other conditions can affect reflexes, too, so people could speak with a doctor to get an official diagnosis wherever possible.
By recognizing and addressing these reflex alterations early, healthcare professionals can ensure appropriate management of hypothyroidism.