Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are\nnot recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few\nother cases of compartment syndrome due to hypothyroidism have been published and the exact\npathophysiological mechanism remains unknown.\nCase presentations: A 59 year old male developed acute compartment syndrome of his right lower leg after\nthyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid\ncancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the\nanterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old\nfemale with Hashimotoâ??s thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid\nhormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was\nperformed. The muscle tissue was viable in all compartments.\nConclusion: Although compartment syndrome due to hypothyroidism is uncommon, it is a complication\nphysicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid\nhormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an\niatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this\nreport, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation\nfor remnant ablation after thyroidectomy.
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