Endocrine Abstracts

Here we present a 49 year-old-male patient with known T1DM, hypothyroidism on Levothyroxine, with previous history of poor compliance with his Levothyroxine. He was admitted with 3 days history of bilateral feet swelling and foot droop. Following the improvement of his leg swellings, his bilateral foot droop became more prominent. He was diagnosed with Hashimoto hypothyroidism with anti TPO ab levels of 279 IU/Ml (reference range: <34 IU/ml) in 2012. His regular medications were Levothyroxine 150 mg OD, Novorapid and Lantus. Our patient complained of bilateral leg swelling and foot droop, which progressed and rapidly deteriorated over a course of three days. This prior to his admission. He was found to have acute kidney injury on admission, this due to the cause of rhabdomyolysis.These were his initial admission investigations:Following these investigations his hepatitis screen was reported as negative. Radiological investigations such as Ultrasound abdomen were reported normal. MRI spine were reported as degenerative changes of the L4/l5 vertebral disc with impingement of L4 nerve bilaterally. However, there were no evidence of significant cord compression. Vasculitis screening such as ANA, ANCA, DsDNA an Anti-GBM were also negative. During his stay in hospital, he was reviewed by neurology and Orthopaedic team. Nerve conduction study indicated peroneal nerve paresis secondary to anterior compartment syndrome. The neurological features were keeping with a peripheral neuropathy secondary to compartment syndrome. This following acute swelling of his lower legs associated with myxoedema and rhabdomyolysis. With Levothyroxine 200 mg once daily and appropriate instruction given to take his Thyroxine, this in order to improve the absorptions in the most effective way, his thyroid function improved rapidly. His TSH levels improved over the next 2 to 3 months.

Conclusion: To conclude, we would like to emphasise the importance of recognising Anterior compartment syndrome associated with Rhabdomyolysis and hypothyroid myopathy. As, Rhabdomyolysis are rare complications of hypothyroid myopathy. Anterior compartment syndrome is most commonly unilateral. However, bilateral involvement has been reported in literature in the past. Bilateral anterior compartment syndrome is rare.