Hypothyroid-induced acute compartment syndrome in all extremities

Abstract

Acute compartment syndrome (ACS) is an uncommon complication of uncontrolled hypothyroidism. If unrecognized, this can lead to ischemia, necrosis and potential limb loss. A 49-year-old female presented with the sudden onset of bilateral lower and upper extremity swelling and pain. The lower extremity anterior compartments were painful and tense. The extensor surface of the upper extremities exhibited swelling and pain. Motor function was intact, however, limited due to pain. Bilateral lower extremity fasciotomies were performed. Postoperative Day 1, upper extremity motor function decreased significantly and paresthesias occurred. She therefore underwent bilateral forearm fasciotomies. The pathogenesis of hypothyroidism-induced compartment syndrome is unclear. Thyroid-stimulating hormone-induced fibroblast activation results in increased glycosaminoglycan deposition. The primary glycosaminoglycan in hypothyroid myxedematous changes is hyaluronic acid, which binds water causing edema. This increases vascular permeability, extravasation of proteins and impaired lymphatic drainage. These contribute to increased intra-compartmental pressure and subsequent ACS.

Hoffmann’s syndrome necessitating forearm fasciotomy: a case report

“…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.…”

“…However, the patient in this previously reported case also presented with acute compartment syndrome of the lower extremities. The previously described bilateral compartment syndrome of the forearms appeared only the day after bilateral lower extremity fasciotomies were performed [5].…”

“…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.…”

Unusual Presentation of Compartment Syndrome

“…An increase in energy demand during mild exercise has been associated with increased risk of rhabdomyolysis in patients with uncontrolled hypothyroidism [39]. These systemic implications of hypothyroidism can explain the reported case of all-extremities compartment syndrome reported in 2016 by Musielak et al [40]. Hypothyroidism can cause dislipidemia, which if treated with statins can both in combination cause rhabdomyolysis and concurrent ACS [41].…”

Hipotiroidizmde Ödem Mekanizmaları

“…Gode bırakmamasının nedeninin proteinden zengin sıvı olduğu için fibroblastlar tarafından kollagen liflere dönüştürülmesi olduğu öne sürülmüştür. TSH'ın fibroblastlarda glikozaminoglikan sentezini uyardığı bildirilmiştir (18). Diğer yandan T3 ve T4 eksikliği glikozaminoglikanların yıkılımını inhibe etmektedir.…”