We report the case of a two-year-old girl whose parents are Moroccan, born in Spain.
There is no family history of consanguinity, thyroid diseases or autoimmune diseases.
The pregnancy, well controlled, had normal thyroid analysis.
She received prophylaxis with potassium chloride (200 μg/day).
I start at 39 weeks.
Birth weight 3334 g (percentile 65 [P65]) and length 49 cm (P40).
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Neonatal hypothyroidism screening was normal.
Psychomotor and weight-height development was normal up to 18 months of age, with a P25-50 of weight and height up to that age.
They consulted at two years for evident growth retardation and symptoms such as apathy, poor playing, lack of language, constipation and loss of appetite.
Examination revealed harmonic hypogrowth: weight 11 500 g (P3) and height 78.5 cm (below P3; -4.0 standard deviations [SD]), body mass index 8.6 kg (BMI2).
There were no edemas, changes in skin color, rough faces, snoring or macroglossia.
There was no goiter.
Neurological examination was normal.
1.
Blood analysis showed high levels of cholesterol (326 mg/dl) to express LDL fraction (250 mg/dl).
Proteinogram with immunoglobulins, celiac antibodies and blood count were normal, without anemia or thrombopenia that could have autoimmune origin.
If there was a fracture (ferritin 9 μg/l [normal 20-20]).
In the study of thyroid function: normal thyroid hormone (TSH) levels of 2375 μU/ml (normal range 0.4-4), undetectable free thyroxine, positive antithyroid antibodies 223/antithyroid hormone
Thyroid ultrasound showed normal thyroid morphology, size and location, with a homogeneous pattern.
The hearing study, which included impedance with reflexes and behavioral audiometry, was also normal.
Treatment with levothyroxine was started, with a dose of 50 μg per day, with TSH levels within 15 days. TSH levels remained normal at 11.42 μU/ml, and TSH levels remained free at 2.20dl.
Clinically, one month after starting treatment, the girl's appearance was awake and her height had improved (79.8 cm [-3.95 SD]), maintaining the same weight.
At nine months, the height was 89.9 cm (-2.53 SD) and the weight was 12 700 g, representing a growth rate of 10.5 cm/year (+3.76 SD) and a BMI of 25.7 kg/m.
Language and communication are improving with the collaboration of the Early Intervention Team, which makes a mature, psychological and language follow-up.
