Endocrine Abstracts

We present the case of a young man who had been known to the endocrine department with difficult to control hyperthyroidism and atrial fibrillation. After a period of treatment with carbimazole, during which he missed several appointments, he was referred for radioactive iodine therapy, which was administered in January 2013. He failed to attend for follow-up appointments and continued to take carbimazole.

He was subsequently referred to the acute medicine department, in May 2013 with bilateral leg pain and suspected DVT. Both legs were swollen, left more than right. He had a foot drop on the left side. Investigations confirmed raised CK at 1295, rising to 12 192. MRI of the left leg suggested myositis but could not exclude acute compartment syndrome.

He underwent left lower limb fasciotomy the following day to relieve pressure in the anterior compartment. Muscle biopsy taken at surgery showed normal architecture, suggesting that permanent damage had been avoided.

He was noted to have raised TSH at 52.8 (NR 0.4 – 4.9) and fT₄ <5.2 (NR 9–19). His carbimazole was stopped and he was started on levothyroxine during his admission. His thyroid status is now normal, though he has a persistent unilateral foot drop.

Acute compartment syndrome has previously been described in primary hypothyroidism and in primary hypothyroidism with co-morbidities including Addison’s, statin use and post-surgery. One report links induced hypothyroidism with acute compartment syndrome with co-existing diabetic neuropathy. Compartment syndrome has not previously been reported in induced hypothyroidism without co-morbidities, and this case highlights the link between thyroid function and acute compartment syndrome, and a particular concern with induced hypothyroidism. The case also raises questions about the use of radioiodine where follow-up is unpredictable.