© Springer India 2016 71
A. Bhansali et al., Clinical Rounds in Endocrinology,
DOI 10.1007/978-81-322-2815-8_3
3 Thyroid Disorders in Children
3.1 Case Vignette
A 14-year-old girl presented with complaints of growth failure and poor develop-
ment of secondary sexual characteristics. She also complained of occasional head-
ache and for that a brain imaging was performed. The MRI of the brain showed a
sellar–suprasellar mass and she was referred to the department of neurosurgery for
surgical intervention. An endocrine consultation was sought prior to subjecting the
patient to surgery. A detailed history was elucidated, which revealed that she had
linear growth failure for the last 7–8 years. She also complained of lethargy, weak-
ness, constipation, cold intolerance, dry skin, and decreased appetite. She studied
till class seventh; however, later she dropped out because of progressive decline in
her scholastic performance. There was history of poor development of secondary
sexual characteristics; however the mother gave a history that the patient had a sin-
gle episode of vaginal bleed at the age of 12 years. She had no history of visual fi eld
defect or diminution of visual acuity. She was residing in iodine-suffi cient area and
had no family history of autoimmune disorders. On examination, her height was
116 cm (−7 SDS, height age 6 years and target height 164 cm), weight 35 Kg
(weight age 10.5 years), pulse rate 64/min, regular and blood pressure 90/60 mmHg.
Her facial features revealed pallor with yellowish hue, periorbital puffi ness, and
depressed nasal bridge. She did not have goiter. Her skin was dry and coarse with
papillomatous eruptions (toad’s skin) and scalp hair was dry, thin, and brittle. Deep
tendon refl exes were grossly delayed particularly the relaxation phase. She also had
myoedema which was elicitable on fl icking the biceps belly with thumb and index
fi nger and showed a post-fl icker mounding phase. She did not have a pseudohyper-
trophy of calf muscle. Other systemic examination was unremarkable. On investiga-
tions, hemoglobin was 8 g/dl with microcytic hypochromic anemia. Liver and renal
function tests were normal. Serum cholesterol was 220 mg/dl, LDL-C 160 mg/dl,
HDL-C 30 mg/dl, and triglyceride 220 mg/dl. Hormonal profi le revealed, serum T 3
0.3 ng/ml (N 0.8–2), T 4 0.3 μg/dl (N 4.8–12.7), TSH 1024 μIU/ml (0.27–4.2), TPO