Juvenile hypothyroidism presenting with hypertrichosis, multicystic ovaries, and pituitary adenoma
A 6-year-old girl was referred for growth of excessive body hair. She was also suffering from poor height gain for 3 years with gradually increasing dryness of skin and lethargy.\nShe was born at full term, her birth weight was 2.25 kg, and she had normal development milestones and average scholastic performance. She did not have excessive somnolence, cold intolerance, constipation, or headache. There was no history of intake of any medication.\nHer height was 104 cm (5th centile target height 159 cm), her weight was 18 kg, and she had normal body proportions. Her pulse rate was 68/min and blood pressure 84/52 mmHg. She had pallor, dry scaly skin and cold extremities. There was a grade1 goiter. Hypertrichosis was particularly noticeable over the lateral aspects of the limbs, the upper back, and forehead []. Her Tanner's sexual maturation score was B1 and P1 for breast and pubic hair, respectively. External genitalia was unambiguously female.\nShe had normocytic normochromic anemia, hemoglobin 10.8 g/dl (normal 12-14 g/dl). TSH was 146 μIU/ml (normal 0.35-5.5), T342 pg/ml (normal 60-181), T40.6 ng/ml (normal 4.5-12.6). The anti-TPO antibody level was 223.05 IU/ml (normal <5.61 IU/ml) and antithyroglobulin level 135.17 (normal <4.17 IU/ml). Testosterone was 0.11 ng/ml (normal <1 ng/ml), 17-hydroxyprogesterone 0.9 ng/ml (normal <2), dehydroepiandrosterone sulfate (DHEAS) 46 μg/dl (normal 16-96), FSH 0.8 mIU/ml (normal 0.3-2.0), LH 0.39 mIU/ml (normal 0.1-6.0), Prolactin 21.2 μg/l (normal 4.7-23.3).\nRadiological investigations revealed a bone age of 4 years (Greulich and Pyle's atlas). Ultrasonography of the pelvis showed a prepubertal uterus of size 2.2 × 1.1 × 0.9 cm with bilaterally enlarged multicystic ovaries (right ovary measuring 2.03 × 1.29 cm and left ovary 2.75 × 1.5 cm with increased ovarian volume) []. Magnetic Resource Imaging scan of sella revealed a sellar mass of 1.5 × 1.3 × 1.0 cm size. Technetium 99 m thyroid scan showed poor and patchy uptake of radiotracer suggestive of thyroiditis.\nA diagnosis of juvenile hypothyroidism due to autoimmune thyroiditis was made and she was started on a levothyroxine in a dose of 50 μg daily. Dose was uptitrated to 75 μg daily and euthyroid status was established. At 6-month follow-up hypertrichosis had nearly regressed. A repeat USG of pelvic organs showed significant reduction in ovarian size. MRI could not be repeated due to financial constraints.