Precocious Puberty as a Result of Congenital Hypothyroidism | BIomedgrid

Precocious Puberty (PP) is widely accepted when secondary sexual characteristics developed before the age of 8 in girls and before the age of 9 in boys [1, 2]. Severe hypothyroidism is a rare cause of precocious puberty. Congenital hypothyroidism, which is one of the causes of PP, occurs in approximately 1:2,000 to 1:4,000 newborns [3, 4]. With the advent of screening of newborn populations, the incidence varies by geographic location, national screening programs, experience and other factors. Precocious puberty is present more commonly in girls than boys [5]. The most common manifestation are the slowing of growth velocity, lethargy, altered school performance, sluggishness, dry skin, constipation, facial puffiness, mild obesity, and less pseudo tumor cerebry and abdominal manifestations such as: acute abdominal distension, intestinal obstruction and gastrointestinal hypomotility etc. [6]. Thyroid hormone is essential for normal growth and neurologic development, particularly in the first few years of life, and hypothyroidism during this period is a leading cause of PP [3,7]. Premature puberty in girls is usually benign. In these rare cases, hypothyroidism leads to growth delay with, paradoxically, precocious puberty. We report a case of a 4.7-year-old girl diagnosed with congenital hypothyroidism who presented with vaginal bleeding, precocious puberty, and a large cyst on the right ovary. Our purpose is to emphasize the importance of hypothyroidism, which is benign and easily treatable, in the differential diagnosis of precocious puberty.