Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jun 5;20(1):80.
doi: 10.1186/s12902-020-00555-y.

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature

Nicole M van Veelen  1 , Stefan Fischli  2 , Frank J P Beeres  3 , Timo Eisenhut  3 , Reto Babst  3 , Christoph Henzen  2 , Björn-Christian Link  3
Affiliations
Case Reports

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature

Nicole M van Veelen et al. BMC Endocr Disord. .

Abstract

Background: Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown.

Case presentations: A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto's thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments.

Conclusion: Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.

Keywords: Compartment syndrome; Hypothyroidism; Myxedema; Rhabdomyolysis; Thyroid gland.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Necrotic tissue in anterior and lateral compartment
Fig. 2
Fig. 2
Flow diagram of study selection
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Taylor RM, Sullivan MP, Mehta S. Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk. Curr Rev Musculoskelet Med. 2012;5(3):206–213. doi: 10.1007/s12178-012-9126-y. - DOI - PMC - PubMed
    1. van Veelen NM, Link BC, Donner G, Babst R, Beeres FJP. Compartment syndrome of the forearm caused by contrast medium extravasation: a case report and review of the literature. Clin Imaging. 2020;61:58–61. doi: 10.1016/j.clinimag.2020.01.013. - DOI - PubMed
    1. Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S. Hypothyroid myopathy: a peculiar clinical presentation of thyroid failure. Review of the literature. Rev Endocr Metab Disord. 2016;17(4):499–519. doi: 10.1007/s11154-016-9357-0. - DOI - PubMed
    1. Balogh ZJ, Butcher NE. Compartment syndromes from head to toe. Crit Care Med. 2010;38(9 Suppl):S445–S451. doi: 10.1097/CCM.0b013e3181ec5d09. - DOI - PubMed
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi: 10.1371/journal.pmed.1000100. - DOI - PMC - PubMed

MeSH terms

Supplementary concepts