When Severe Hypothyroidism Mimics Neuromuscular Diseases: A Case Supporting Outpatient Management in Contemporary Endocrinology

Background: Severe hypothyroidism may present with symptoms that resemble primary neuromuscular or acute neurological disorders, leading to diagnostic delays and potentially unnecessary hospitalizations. Case: A 38-year-old man presented with postural instability, diplopia, myalgia, and elevated CK, suggestive of a neuromuscular disorder. Labs revealed TSH > 170 μU/mL and suppressed fT4. Despite severe biochemistry, clinical stability allowed for outpatient management with levothyroxine and endocrinology follow-up. Discussion: The case mimicked inflammatory myopathy and brainstem stroke, but absence of red flags enabled safe outpatient treatment. Literature confirms that hypothyroidism can present with neurologic signs and that structured outpatient pathways are effective. Conclusion: This case highlights the importance of recognizing endocrine causes in neuromuscular presentations and supports outpatient management models for stable hypothyroid patients. Keywords: hypothyroidism; neuromuscular disorders; acute neurological disorders; unnecessary hospitalization; outpatient management.