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Joseph Junewick, MD FACR
over 8 years ago
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Severe Juvenile Hypothyroidism

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Metabolic
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: CR
Activities:
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History

9 year old female with growth deceleration (75th percentile at age 6 to < 3rd percentile at age 9) found to be severely hypothyroid.


Case Images


Diagnosis

Severe Juvenile Hypothyroidism

Findings

CR – Osteopenia with irregularly sclerotic zones at the physes and physeal equivalents.

Discussion

Hypothyroidism (decreased T3) has multiple effects on growth centers (physes and physeal equivalents): 1) Reduction in reserve zone chondrocytes, 2) Failure of proliferative chondrocyte organization into discrete columns, 3) Diminished hypertrophic zone, 4) Decreased vascular and osteoblastic invasion and 5) Altered matrix composition. These changes result in deficient mineralization of cartilage and osteoid and retarded enchondral ossification similar to rickets.

Reference

Rivkees SA, Bode HH, Crawford JD. Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature. N Engl J Med 1988;318:599-602.

Shore RM, Chesney RW. Rickets:Part 1. Pediatr Radiol (2013); 43:140-151.



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