Rhabdomyolysis and peroneal nerve compression associated with thyroid hormone withdrawal in the setting of remnant ablation: review of the literature.

Objective: To review the putative mechanisms whereby hypothyroidism is associated with severe myopathy, neural injury, and acute compartment syndrome and report a case of nontraumatic common peroneal nerve compression associated with hypothyroidism-induced rhabdomyolysis in a patient with diabetes prepared for remnant ablation after thyroidectomy for differentiated thyroid carcinoma.

Methods: We performed a review of the English-language literature on the PubMed database using the terms hypothyroidism, muscle disease, hypothyroid myopathy, rhabdomyolysis, compression neuropathy, and acute compartment syndrome.

Results: Myopathy occurs frequently among patients with overt hypothyroidism; however, severe myoneural injury seems to be precipitated or accompanied by comorbid conditions. Focal peroneal neuropathy may be related to hypothyroidism-induced extrinsic compression from severe myopathy and soft tissue swelling in a narrowed fascial compartment.

Conclusion: Severe short-term iatrogenic hypothyroidism may lead to severe myopathy and compression nerve injury in patients with underlying diabetic neuropathy. We recommend avoidance of withdrawal of thyroid hormone for purposes of remnant ablation among patients with preexisting diabetic neuropathy.