72
1200 IU/ml ( N < 34), prolactin 50 ng/ml (N 4.7–23.3), LH 0.8 mIU/ml (N 2.4–
12.6), FSH 8.6 mIU/ml (N 3.5–12.5), estradiol 15 pg/ml (N 12.5–166), and 0800h
cortisol 170 nmol/L (N 171–536). Bone age was 6 years and there was no epiphy-
seal dysgenesis. CEMRI sella revealed a 1.5 × 1.8 cm homogeneously enhancing
sellar–suprasellar mass, while the rest of the brain parenchyma was unremarkable.
Ultrasound pelvis showed bilateral enlarged multicystic ovaries with small uterus
and endometrial thickness of 1 mm. With this clinical and biochemical profi le, she
was diagnosed as a case of long-standing, untreated juvenile primary hypothyroid-
ism of autoimmune origin (Hashimoto’s thyroiditis) with thyro- lactotrope hyperpla-
sia and multicystic ovaries. She was initiated with L-thyroxine at a dose of 25 μg/
day, with a weekly increase by 25 μg till a dose of 100 μg/day was attained. In addi-
tion, hydrocortisone was also added at a dose of 10 mg/day in divided doses. At
6 weeks of follow-up, serum T 4 was 6.6 μg/dl and TSH 15 μIU/ml. With initiation
of treatment, she had polyuria which abated later. The dose of L-thyroxine was
increased to 125 μg/day and hydrocortisone was withdrawn, and the repeat serum
0800h cortisol after 24h of omission of hydrocortisone was 390 nmol/L (Figs. 3.1
and 3.2 ).
acbFig. 3.1 ( a ) A 14-year-old child with myxoedematous features, ( b ) short stature with poor sec-
ondary sexual characteristics ( c ). Note the breast budding (B 2 ) in the same child
3 Thyroid Disorders in Children