Endocrine Abstracts

15-year-old girl presented to the psychiatrist with behavioural problems, fluctuation in mood, paranoia, low self-confidence and school refusal. She presented to her GP 4 months later with history of increased body hair and irregular menstrual pattern. Her sex hormone binding globulin was low. Luteinising hormone, follicular stimulating hormone and testosterone levels were normal. Pelvic ultrasound showed both ovaries contain multiple follicles suggestive of polycystic ovary disease. She was diagnosed with polycystic ovarian disease and started on combined oral contraceptive pills. Baseline blood tests done prior to starting Quetiapine (antipsychotic) by psychiatrists 9 months after onset of her symptoms showed thyroid stimulating hormone was markedly raised at 165 and T4 was <1.9. She was referred to the paediatric team with these results.

She was seen by the paediatric team with history of cold intolerance, ongoing behavioural problems, scalp hair loss, increased tiredness and increased body weight. She was 72.1 kg (91st–98th centile), height 152.5 cm (2nd–9th centile), BMI 31.6. She had a small diffuse goitre with no palpable cervical lymph nodes and dry skin on examination. The rest of her examination was unremarkable. Her Luteinising hormone, Follicular stimulating hormone, Liver function tests, coeliac screen, prolactin, thyroid peroxidase antibodies and testosterone levels were normal. MRI head showed no space occupying lesions or haemorrhage and normal pituitary fossa.

She was started on Thyroxine 50 μg and later increased to 75 μg. There is marked improvement in thyroid function and behaviour. Quetiapine was stopped within two months of thyroxine therapy.

We found two reports of child psychosis due to hypothyroidism in literature. It is well recognised in adults but rare in childhood. Children presenting with behavioural problems should be checked for possible organic causes especially metabolic conditions such as hypothyroidism as this could be the first presenting feature has seen in this case.