Background: Children with severe hypothyroidism are known to present with significant growth restriction. Institution of treatment with thyroxine (T4) results in catch-up growth. However, treatment commenced in pubertal period may result in loss of adult height in cases with longstanding severe hypothyroidism.
Objective and hypotheses: The objective of our study is to evaluate the presentation, investigations and catch-up growth after initiation of treatment with T4.
Method: We describe a retrospective case series of three peripubertal girls who presented with severe growth restriction as a result of primary autoimmune hypothyroidism between September 2014 and April 2015.
Results: Case 1: A 15-year-old girl presented with 1-year history of constipation and short stature, but no history of dry skin, cold intolerance, hair loss or lethargy. Her pubertal staging was B3P3A2M1. Her height SDS was −4.99 and weight SDS was −3.22. Her TPO antibodies were positive. Her bone age was delayed by 5 years. 6 months after starting treatment with T4, her height SDS improved to −3.83. Case 2: A 13-year-old girl presented with 1-year history of cold intolerance, poor growth, low mood and constipation. Her pubertal staging was B3P3A2M1. Her height SDS was −3.23 and weight SDS was −0.61. Her bone age was delayed by 2 years. 6 months after commencing treatment with T4, her height SDS had improved to −2.69. Case 3: A 14-year-old girl presented with dizziness and collapse at school. She also had two-year history of cold intolerance, dry skin and dry hair. Her pubertal staging was B2P2A1M0. Her height SDS was −4.35 and weight SDS was −1.93. Her bone age was delayed by 3.8 years. 6 months after starting treatment with T4, her height SDS improved to −3.43. TSH was >100 mU/l, Free T4 was undetectable and thyroid ultrasound scan was suggestive of thyroiditis with no nodules in all three girls at presentation. Normal GH reserve was demonstrated in all girls by arginine stimulation test.
Conclusion: Prompt recognition of hypothyroidism in early childhood is essential to initiate treatment early, so that adult height is not compromised.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology