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Introduction. Dropped head syndrome results from neck extensor weakness, and is commonly due to neuromuscular disorders such as inflammatory myopathies, myasthenia gravis, or amyotrophic lateral sclerosis. We describe, with neck muscle imaging findings, a man presenting with neck extensor weakness due to hypothyroidism that resolves with thyroxine replacement. Results. A 60-year-old man without any past medical history of note presented with neck pain for 7 years. On examination, he was noted to have head drop, without limb weakness, bulbar symptoms nor fatiguability. Neurologic examination was otherwise normal. Creatine kinase (CK) was raised at 2480 U/L. Thyroid-stimulating hormone (TSH) was high at 64.50 mIU/L (Normal 0.45-4.50 mIU/L), and T4 was low at < 3.2 pmol/L (Normal 8-16 pmol/L). Thyroid peroxidase and anti-thyroglobulin antibodies were positive. Antiacetylcholine receptor and myositis-specific antibodies were negative. Repetitive nerve stimulation was negative. Needle electromyography showed evidence of an irritable myopathy in the deltoid, iliopsoas and neck extensors. Computed Tomography of the neck showed hypertrophy of the splenius capitis. He was diagnosed with myopathy due to hypothyroidism and started on levothyroxine replacement. 6 months' later, there was resolution of his dropped head with normalization of his CK levels. Conclusion. Hypothyroidism more commonly presents with proximal limb weakness or raised CK. Associated axial myopathies are very rarely described. Hypothyroidism is a treatable cause of dropped head syndrome that reverses with thyroxine replacement. It is a rare cause of neck extensor muscle hypertrophy and irritable myopathy. Recognizing this entity is important to avoid unnecessary invasive investigations, such as muscle biopsy, or unnecessary immunomodulatory treatment in a neck extensor myopathy that will self-resolve with normalization of thyroid function. Muscle imaging can be helpful in its diagnosis. [ABSTRACT FROM AUTHOR]

• Commonly reported symptoms are headache, throat pain and lethargy. • A large number of healthcare workers report more than four symptoms. • Those with physical symptoms had higher rates of depression, anxiety, stress, PTSD. • Those with physical symptoms had higher mean scores in the IES-R, DASS subscales. • Association between physical symptoms and psychological outcomes may be bidirectional. Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54–5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36–3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27–7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12–4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded. [ABSTRACT FROM AUTHOR]