SAT-350 Hypothyroidism and a Case of Aching Limbs

Abstract Disclosure: H. Khan: None. B. Ahmed: None. Introduction: Acute compartment syndrome (CS) is defined as increased pressure within a closed osteo-fascial compartment, resulting in impaired local circulation and subsequent nerve and muscle ischemia. To the best of my knowledge, we are presenting the second case of severe hypothyroidism leading to compartment syndrome in all four extremities. Case Report A 58-year-old female presented to the emergency department (ED) with complaints of severe bilateral leg pain for one month.Initial evaluation revealed acute kidney injury and elevated creatine kinase (CK) levels, leading to a diagnosis of non-traumatic rhabdomyolysis. This was initially attributed to statin use, as her outpatient medication list included rosuvastatin 40 mg daily.However, her thyroid-stimulating hormone (TSH) level was markedly elevated (108.7 µIU/mL), and her clinical presentation (bradypnea, bradycardia, myxedema of extremities, and muffled voice) pointed to severe hypothyroidism as the predominant etiology. Corroborating the medication list with family and pharmacy revealed that she had not been taking any medications in recent month because of feeling depressed. This effectively rules out the contribution of statins in clinical deterioration.The vascular surgery team evaluated patient’s extremities and diagnosed compartment syndrome. Emergent fasciotomy was performed on all four limbs. Patient also developed significant bradypnea requiring emergent intubation The patient was started on 150 µg of intravenous levothyroxine after receiving an initial dose of stress-dose steroids.Over the subsequent two weeks, the patient’s clinical status improved. She was discharged to a rehabilitation facility with a TSH level of 40.2 µIU/mL and CK levels down-trending from a peak of 21,455 U/L to 6,116 U/L. Discussion: Association of CS with severe hypothyroidism is exceedingly rare,however it could also possibly be an underrecognized association.In this patient clinical signs of myxedema and labs identified hypothyroidism as the primary driver of non-traumatic rhabdomyolysis leading to CS. Initially,statin-induced rhabdomyolysis was a plausible consideration. However, the absence of medication adherence and significant hypothyroid symptoms redirected the diagnosis, underscoring the importance of maintaining a high index of suspicion for hypothyroidism in patients presenting with rhabdomyolysis and the need for avoiding anchoring bias during diagnosis.The severity of the case requiring fasciotomy in all four limbs, emphasizes the critical nature of early recognition and intervention.Few reports have documented hypothyroidism as a cause of compartment syndrome, making this case an important contribution to the literature. Presentation: Saturday, July 12, 2025