SHM Converge Scientific Abstract ePoster Gallery-Recurrent Nontraumatic Acute Compartment Syndrome Induced by Hypothyroid Myxedema

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This case report describes a rare instance of <strong>recurrent, nontraumatic acute compartment syndrome (ACS)</strong> caused by <strong>hypothyroid myxedema</strong> in a 42-year-old man with iatrogenic hypothyroidism after radioiodine ablation for Graves’ disease. He had previously suffered right leg ACS seven years earlier, requiring fasciotomy, after stopping thyroid replacement therapy.

The current episode developed after he again discontinued thyroid medication during a period of prolonged grief. He presented with <strong>3 days of worsening left leg pain, swelling, paresthesia, severe tenderness, compartment tension, non-pitting edema, and reduced ankle movement</strong>. Labs showed marked hypothyroidism and muscle injury, including <strong>TSH 61.9 µU/mL, low free T4, CPK 24,823 U/L, and elevated AST/ALT</strong>. Compartment pressure in the anterior leg compartment was <strong>195 mmHg</strong>, confirming severe ACS.

He underwent <strong>emergency four-compartment fasciotomy</strong>, which showed ischemia in the anterior and lateral compartments, followed by several incision and debridement procedures. Thyroid hormone replacement was restarted intravenously and orally. He was discharged with a wound VAC, viable muscle, and referral for skin grafting.

The report emphasizes that <strong>hypothyroidism should be considered in unexplained limb swelling and suspected ACS</strong>, especially in patients with myxedema or medication nonadherence. Recommended evaluation includes <strong>TSH, free T4, creatine kinase, and compartment pressure measurement</strong>. Early surgical decompression is critical to prevent permanent neuromuscular damage and disability.

The authors note this is the <strong>first documented recurrent ACS linked to hypothyroidism</strong>, and suggest possible mechanisms such as <strong>muscle hypertrophy, increased vascular permeability, impaired lymphatic drainage, and accumulation of interstitial glycosaminoglycans</strong>.

Asset Subtitle

Tony Tran

Meta Tag

Author List Otto Leiti, Tony Tran, Yetunde Balogun

Category Clinical Vignettes

Concept Compartment Syndrome

Concept Compartment Pressure

Concept Hypothyroidism

Concept Decompression

Concept Ischemia

Distinguished Non-Finalist

Presenter Organization Michigan State University College of Human Medicine

Presenting Author Tony Tran

Track Adult

Keywords

acute compartment syndrome

hypothyroid myxedema

recurrent ACS

iatrogenic hypothyroidism

fasciotomy

leg swelling

creatine kinase

compartment pressure

thyroid hormone replacement

Graves disease

Compartment Syndrome

Compartment Pressure

Hypothyroidism

Decompression

Ischemia