Bilateral Lower Extremity Anterior Compartment Syndrome in a Severely Hypothyroid Patient

Hariri, Nizar; Mousa, Albeir Y.; Abu-Halimah, Shadi; Richmond, Bryan K.

doi:10.1177/000313481408001204

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Hoffmann's syndrome is a rare condition, and to the best of the authors' knowledge it has not been previously reported in Scandinavia. Fasciotomy in this setting is even more extraordinary, with only a few published cases [1][2][3][4][5]. In contrast to previously published cases, the compartment that was affected in this case report was the dorsolateral compartment of the forearm, whereas the patients in previous reports all presented with compartment syndromes of tibial compartments.…”

Section: Discussioncontrasting

confidence: 62%

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Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

et al. 2020

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Background: Hoffmann's syndrome is a rare form of hypothyroid myopathy. Only a few cases of fasciotomy in this setting have previously been reported. Case presentation: A 41-year-old Caucasian man under treatment for hypothyroidism presented with acute-onset severe pain in his forearm for no obvious reason and was admitted to our emergency room. He eventually developed compartment syndrome which necessitated surgical decompression. Soon after surgery he complained of similar symptoms in his calves. By the time his hypothyroid status was confirmed, conservative treatment and orally administered levothyroxine gradually made the pain from his calves disappear, without further surgical treatment. Conclusion: Hoffmann's syndrome may precipitate a compartment syndrome in the absence of trauma.

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Section: Discussioncontrasting

confidence: 62%

“…The lower leg seems to be the most common location of compartment syndrome associated with hypothyroidism, with five previously published cases involving fasciotomy of tibial compartments [1][2][3][4][5]. To the best of our knowledge, only one patient with hypothyroid-induced compartment syndrome in the forearm has previously been reported.…”

Section: Discussionmentioning

confidence: 98%

Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

et al. 2020

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“…These findings suggest an increase in the volume of the compartment contents [7] which could lead to compartment syndrome. However, as mentioned above, Hoffmann's syndrome usually involves the gastrocnemius, whereas in our cases and all but one of the other case reports [6,[8][9][10][11][12] we found, the anterior and lateral muscles were predominantly involved. A connection between Hoffman's syndrome and compartment syndrome therefore seems unlikely.…”

Section: Discussionsupporting

confidence: 48%

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

et al. 2020

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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.

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Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature

Sindoni

Rodolico

Pappalardo

et al. 2016

Rev Endocr Metab Disord

103

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Abnormalities in thyroid function are common endocrine disorders that affect 5-10 % of the general population, with hypothyroidism occurring more frequently than hyperthyroidism. Clinical symptoms and signs are often nonspecific, particularly in hypothyroidism. Muscular symptoms (stiffness, myalgias, cramps, easy fatigability) are mentioned by the majority of patients with frank hypothyroidism. Often underestimated is the fact that muscle symptoms may represent the predominant or the only clinical manifestation of hypothyroidism, raising the issue of a differential diagnosis with other causes of myopathy, which sometimes can be difficult. Elevated serum creatine kinase, which not necessarily correlates with the severity of the myopathic symptoms, is certainly suggestive of muscle impairment, though it does not explain the cause. Rare muscular manifestations, associated with hypothyroidism, are rhabdomyolysis, acute compartment syndrome, Hoffman's syndrome and Kocher-Debré-Sémélaigne syndrome. Though the pathogenesis of hypothyroid myopathy is not entirely known, proposed mechanisms include altered glycogenolytic and oxidative metabolism, altered expression of contractile proteins, and neuro-mediated damage. Correlation studies of haplotype, muscle gene expression and protein characterization, could help understanding the pathophysiological mechanisms of this myopathic presentation of hypothyroidism.

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Bilateral Lower Extremity Anterior Compartment Syndrome in a Severely Hypothyroid Patient

Cited by 4 publications

References 5 publications

Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

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

Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature

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