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Acquired hypothyroidism — RACP Paediatrics MCQ

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EasyEndocrinology and growthAcquired hypothyroidismRACP Paediatrics

An 8-year-old has declining school performance, constipation and poor linear growth over 18 months. She has dry skin, delayed relaxation of reflexes and a small goitre; TSH is 85 mIU/L and free T4 is low. What is the most likely diagnosis?

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Correct answer: C — Acquired primary hypothyroidism

High TSH with low free T4 confirms primary hypothyroidism, which explains poor growth, constipation, dry skin and cognitive slowing. Constitutional delay would not cause biochemical hypothyroidism or goitre. The pearl is that acquired hypothyroidism can present primarily as growth failure rather than overt fatigue.

Reference: Therapeutic Guidelines (eTG): Endocrinology; RCH Clinical Practice Guidelines