A CASE OF HYPOTHYROIDISM WITH DELAYED PUBERTY AND PUBERTY MENORRHAGIA
#1

Presented by:
Dr. K. Sowmya

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A CASE OF HYPOTHYROIDISM WITH DELAYED PUBERTY AND PUBERTY MENORRHAGIA
Present complaint started 15 days back as heavy periods associated with clots wetting 4-5 diapers / day and continued till now.
 The bleeding is not associated with pain.
 H/o. cold intolerance
 H/o. constipation
 There is h/o. 4 months amenorrhea before the starting of bleeding.
 No h/o. similar complaint previously.
 No h/o injury. No h/o fever.
 No h/o spontaneous or induced abortion
 No h/o D & C
 No h/o steroid therapy for any reason
 No h/o bleeding disorder in the past or in the family
 No h/o administration of anticoagulants for any reason.
 Gynaec h/o
 Attained menarchy at the age of 24 years i.e., 1 year back.
 Menstrual history – bleeding for 4-5 days wetting 3-4 diapers / day, heavy flow, associated with clots every 2-3 months and not associated with pain.
 LMP - 15 days
 Past h/o
 There is no h/o similer complaint previously
 No h/o bleeding disorder
 No h/o TB, Asthma
 No h/o drug allergy
 No previous h/o blood transfusion
 Personal h/o
 She takes mixed diet
 Sleep & apetite – normal
 Intelligence - normal
Studied upto – 10th class
 h/o constipation - present
 Family h/o
 Sibling history
 She is the youngest girl of 4 sisters, all the other 3 girls and parents are normal.
 No h/o similar complaint in her siblings.
 No h/o genetic disorders in family.
 No h/o consaguinous marriage of her parents.
 No h/o bleeding disorders.
 No h/o HTN, DM
 General examination
 She is short statured with height 123 cm & wt. 38 kg.
 Moderately nourished
 Secondary sexual characters are not well developed – Tanner B2 PH1 stage
- No axillary hair
 Coarse facial features s/o hypothyroidism
 Dry mottled skin
 Coarse facial features
 Broad flat nose
 Puffy face
 There is no lymphadnopathy
 Brests – B2 tanner stag.
 Thyroid – No goitre
 Severe anaemia
 No jaundice
 No oedema feet
 No clubbing
 No cyanosis
Vital parameters
 Temp – Normal
 PR : 72/mt, regular, low volume.
 BP : 80 / 50 mm hg
 RR : 24/mt
Systemic examination
 Cvs S1+ S2+, no added sounds
 Resp. system : clear
Bilateral air entry normal
Gynecological examination
Abdomen :
 Inspection :
 Skin over the abdomen – normal
 No visible or engorged veins
 There are no scars
 Umbilicus – normal, not everted
 All quadrants are moving equally with respiration
 All hernial orifices are normal.
Palpation
 No tenderness
 No rigidity, No gaurding
 No palpable lumps
 Pelvic examination :
 External genitalia – infantile
 Pubic hair PH1 stage
 Bleeding p/v present
Investigations
 Complete Haemogram
 HB % = 3.8 gm %
 TRBC = 0.50 milions / cumm
 TWBC = 8,600 / cumm
 DC = P-75%, L – 21% E – 04%
 ESR = 20 mm / 1st hr
 Platelet count = 1,02,000 /cumm
 PCV = 4 ml %
 BT = 2’ 50”
 CT = 5’ 20”
Peripheral Smear
 RBC – microcytic, hypochromic RBC with anisocysosis, occasional target cells.
 WBC – TC, DC with in normal limits.
 No abnormal cells.
 Platelets – around lower normal range seen diserete
 No haemoparasites
Impression : microcytic, hypochromic anaemia. Correlate clinical
 Blood group & Rh type : A+ve
 RBS – 102 mg / dl
 Blood urea – 36 mg / dl
 Serum creatinine - 1.3 mg / dl
 HBs Ag – Negative
 HIV – Non reactive
Thyroid profile
 T 3 - 0.29 ng / dl
 T 4 - 1.04 µg / dl
 TSH - 200 mU / Lt
 FSH
 LH
 Oestrogen
 Prolactin
 Testosterone
 CT Scan
 MRI Scan
 Buccal smear
 Karyotyping
USG
 Uterus : 8 cm x 4 cm x 3 cm
 Endometrium – Collection noted in uterus more in lower uterine segment and external os region and vagina
 Rt ovary not visualised
 Lt ovary normal
Diagnosis
 Hypothroidism with delayed puberty & puberty menorrhagia
Treatment given
 5 units of blood transfusion done
 Tab Eltroxin 100 µg / day
 Progesterone (Regesterone) started at 25 mg/day as 5 mg 5 times a day and tapered to 5 mg Od in 5 days and advised to continue it for 20 days.
 Advised review after one week - no follow up.
Reply
#2

exalent presentation .hypothyroid at puberty is the diognosis you have made but it is there since childhood as per the history and other findings .Is it necesory to treat first treat hypothyroid state or simulations
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