Endocrine Abstracts

Severe hypothyroidism is a rare cause of precocious puberty, because long-standing primary hypothyroidism traditionally leads to both pubertal and growth delay. We report a case of a 4.7 year old girl presented with abdominal/pelvic pain and vaginal bleeding since 1 week. The child was diagnosed as a case with a right ovarian mass and was planned for surgery. She was born at term pregnancy without complication. Physical examination revealed typical features of hypothyroidism. Growth velocity was decreased and contrasted with exaggerated weight gain. She weight 21 kg (weight 90th percentile), height was 92 cm (height <3rd percentile), stature development was 2 year and 9 months, bone age corresponding to 1 year. Breast development was at stage II (S2), no axillary (A0) and no pubic hair (PO). The serum thyroid-stimulating hormone level was enlarged >75 mIU/l (range 0.3–5.0), total thyroxine (TT₄) and total triiodothyronine(TT₃) were undetectable, follicle stimulating (FSH) was 5.1 UI/l (3–8), and luteinizing (LH) 0.2 UI/l (range 1–7), prolactin was elevated, at 29.6 ng/ml (2.7–8.7). Thyroid ultrasound showed absence of thyroid gland in normal location. Scintigraphy with Technetium 99 showed light isotope uptake in the sublingual region and absence of isotope uptake in the normal thyroid position. These results were consistent with the diagnosis of primary hypothyroidism as a result of thyroid agenise. She was treated with L-thyroxin 25 μg/day for the first two weeks than to 50 μg once daily fasting in the morning. Vaginal bleeding was stopped after few days that we start treatment and was not seen again. Breast development, size of uterus and ovaries returned to the prepubertal stage after 6 months of the L-thyroxin therapy.

In conclusion children with precocious puberty having solitary masses on ovary, decreased growth velocity and bone age delay should be assessed for hypothyroidism in order to avoid unnecessary surgery on the ovaries.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.