Working Diagnosis:
Chronic Exertional Compartment Syndrome Secondary to Chronic Hypothyroidism

Treatment:
She underwent bilateral tricompartmental decompressive fasciotomies and subsequent physical therapy for rehabilitation.

Outcome:
She progressed well and six weeks after surgery she was cleared to return to sport without limitations. This is consistent with prior studies showing a majority of athletes status post decompressive fasciotomy were able to return to their elite level of sport at a mean of 10.6 weeks post operatively. After a couples months of treatment her TSH normalized and she no longer felt fatigued.

Author's Comments:
This patient's presentation of a young endurance athlete who developed bilateral exertional lower extremity pain that resolved with rest is classic for chronic exertional compartment syngrom (CECS). Her lab findings of an elevated TSH, suppressed free T4, and an elevated thyroid peroxidase antibody level are consistent with a diagnosis of Hashimoto's thyroiditis. In a review of literature, the first case report linking hypothyroidism to compartment syndrome was published in 1993, and since then there have only been a handful of publications linking the two conditions, all involving adults with acute compartment syndrome (ACS) presenting with foot drop or severe, crippling pain. To our knowledge, this is the first case linking hypothyroidism to chronic exertional compartment syndrome.

Editor's Comments:
This is a very unusual case associating CECS with hypothyroidism. It would have been interesting to see if symptoms normalized once she became euthyroid with medical management. The case highlights the importance of considering systemic conditions in the sports medicine clinic.

References:
Barnes, M. "Diagnosis and Management of Chronic Compartment Syndromes: A Review of the Literature." British Journal of Sports Medicine 31.1 (1997): 21-27. Print.

Detmer, Don E., Kim Sharpe, Robert L. Sufit, and Forrest M. Girdley. "Chronic Compartment Syndrome: Diagnosis, Management, and Outcomes." The American Journal of Sports Medicine 13.3 (1985): 162-70.

Musielak, Matthew C., and Jung Hee Chae. "Hypothyroid-induced Acute Compartment Syndrome in All Extremities." Journal of Surgical Case Reports 2016. 12 (2016): n. pag.

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