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Untreated disease can lead to fatigue, reduced activity, impaired growth, disordered puberty, and long-term neurocognitive harm.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/atypical-presentations-of-primary-acquired-hypothyroidism-a-case-series/496381/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/atypical-presentations-of-primary-acquired-hypothyroidism-a-case-series/496381.png","ImageObject",300,407,{"name":42,"@type":43},"Ezra","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-10-02",true,{"@type":52,"interactionType":53,"userInteractionCount":33},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Why are atypical presentations of acquired primary hypothyroidism important in children?","Question",{"text":62,"@type":63},"They are often insidious and can appear as non-specific symptoms in other specialties before endocrinology referral. Early recognition helps prevent harmful long-term outcomes.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What clinical feature is highlighted as a hallmark in affected children?",{"text":67,"@type":63},"Growth failure is described as a hallmark feature, and it should be identified using detailed history, physical examination, and growth chart analysis.",{"name":69,"@type":60,"acceptedAnswer":70},"How can untreated primary acquired hypothyroidism affect children over the long term?",{"text":71,"@type":63},"The document links untreated hypothyroidism to fatigue, decreased physical activity, suboptimal height gain, disordered puberty, and poor neurocognitive development.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},496381,1792663341,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":110,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":117,"preview_page_count":4},1099514068035,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Pravin etal. BMC Endocrine Disorders (2023) 23:242  \n[https://doi.org/10.1186/s12902-023-01488-y](https://doi.org/10.1186/s12902-023-01488-y)  \nBMC Endocrine Disorders  \nCASE REPORT Open Access  \nAtypical presentations of primary acquired hypothyroidism – a case series  \nR. R. Pravin 1,2*, Sheau Yun Kan 1, Ser Yee Soh1,2, Daniel Chan2,3,4,5 and Rashida Farhad Vasanwala2,3,4,5  \nAbstract  \nPrimary acquired hypothyroidism in children manifests with a myriad of clinical presentations. Clinical features can be insidious in nature, often under the guise of non-specific presentations to other subspecialties prior to referral to the endocrinologist. Growth failure is a hallmark feature in these children alongside their presenting clinical symptomology which needs to be identified through detailed history, physical examination and analysis of the growth charts. In this case series, we discuss 5 atypical presentations of acquired primary hypothyroidism with multisystemic involvement, including musculoskeletal, hepatobiliary, gynaecological and haematological manifestations. This is of importance as untreated hypothyroidism leads to fatigue, decreased physical activity, suboptimal height gain, disordered puberty and poor neurocognitive development in children with long term detrimental outcomes.  \nKeywords Hypothyroidism, Thyroid, Growth, Puberty  \nIntroduction  \nAtypical presentations of acquired primary hypothyroidism are not well described in the paediatric population, although this may be more common than congenital hypothyroidism. Based on limited studies, it has a prevalence of 1:740 (0.135%) as compared to congenital hypothyroidism which has a prevalence of 1:3000–4000 live births (0.027%). [1]. Common aetiologies of acquired primary hypothyroidism include autoimmune thyroiditis,  \n*Correspondence:  \nR. R. Pravin [rr.pravin@mohh.com.sg](rr.pravin@mohh.com.sg)  \n1General Paediatrics, KK Women’s & Children’s Hospital, Singapore, Singapore  \n2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore  \n3Endocrinology Service, KK Women’s & Children’s Hospital, Singapore, Singapore  \n4Duke-NUS Medical School, National University of Singapore, Singapore, Singapore  \n5Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore  \npost-thyroidectomy, or iodine deficiency which is more commonly seen in resource-poor countries [2].  \nDecrease in growth velocity is the most sensitive presentation of this insidious condition, which may also present with a host of other symptoms including development of a goitre, weight gain, myxedema, dry skin, alopecia, cold intolerance, impaired school performance and constipation. Rarer manifestations include pseudoprecocious puberty, coagulopathy presenting as menorrhagia, hyperprolactinemia resulting in pubertal delay and secondary amenorrhoea [3]. It is crucial to identify this condition early, as failure to do so leads to detrimental outcomes such as impaired growth, delayed puberty [4] and poor neurocognitive development [5].  \nRare presentations of acquired hypothyroidism have been described in isolated case reports. However, this case series comprises of mostly atypical and typical presentations of acquired primary hypothyroidism. Early identification and initiation of levothyroxine replacement was pivotal in these cases as there was significant clinical  \n© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the artic","cbCaibbcHclRePp0","https://ap.wps.com/l/cbCaibbcHclRePp0","pdf",1692264,"English","# Abstract\n# Introduction\n# Case Report 1\n## Fixing a bone, mending a hormone","[{\"question\":\"Why are atypical presentations of acquired primary hypothyroidism important in children?\",\"answer\":\"They are often insidious and can appear as non-specific symptoms in other specialties before endocrinology referral. Early recognition helps prevent harmful long-term outcomes.\"},{\"question\":\"What clinical feature is highlighted as a hallmark in affected children?\",\"answer\":\"Growth failure is described as a hallmark feature, and it should be identified using detailed history, physical examination, and growth chart analysis.\"},{\"question\":\"How can untreated primary acquired hypothyroidism affect children over the long term?\",\"answer\":\"The document links untreated hypothyroidism to fatigue, decreased physical activity, suboptimal height gain, disordered puberty, and poor neurocognitive development.\"}]","Atypical presentations of primary acquired hypothyroidism – a case series | PDF",1790931431]