Endocrine Abstracts

Case summary: 7 yr old girl referred by GP to the cardiology clinic with heart murmur. Mother reported to GP about facial and periorbital puffiness intermittently for the last 2 years. Cardiology clinic review showed 1/6 short systolic murmur with small pericardial effusion. Pericardial effusion was initially thought to be possible post viral illness and the facial puffiness which remained unexplainable. A repeat Echo at 3 months later showed persistence of pericardial effusion, hence blood test including thyroid function was done as hypothyroidism is one of the rare causes of pericardial effusion and showed a high TSH >150 mU/L free T4 <1 pmol/L. On further review in the endocrine clinic mother reported slow growth and she was very cold all the time, with swollen feet. On physical examination she had dry skin, coarse facies, facial puffiness, swelling of hands and feet and no goitre Her weight was 30.8 kg >50 th centile height 124.6 cm, (2nd – 9th centile) with mid parental centile above 50 th centile. Insulin like growth factor was low (7 nmol/L), anti-thyroid peroxidase antibody was high (>3000 iu/mL), anti-tTG and anti-endomysial Ab were mildly elevated. Her bone age was delayed by 3 years. She was started on Levothyroxine and dose increase gradually. Her growth parameters improved significantly with height above 50th centile within 8 months of treatment, insulin growth factor normalised. She had lost 4 kg in weight in the first 3 months of starting treatment due to resolving pedal oedema then continue to improve in weight and maintained on 75th centile. Pericardial effusion resolved completely on repeat ECHO. She is under follow-up of gastroenterology for weakly positive coeliac screen but there is no family history of coeliac disease, and she has no gastrointestinal symptoms and awaiting duodenal biopsy for confirmation.

Discussion: Autoimmune hypothyroidism is the most common cause of acquired hypothyroidism children. Pericardial effusions are rare complication in children. Early recognition and replacement can prevent serious complications.

Conclusion: Growth assessment in children is essential across all paediatric specialities and helps to explore further relevant history to initiate appropriate investigations and management without delay.