PEDIATRICS Vol. 108 No. 5
November 2001,
p. e96
ELECTRONIC ARTICLE:
Unmasking of Childhood Hypothyroidism by Disseminated Xanthomas
Received May 8, 2001; accepted Jul 5, 2001.
Jörg Dötsch,
Kristina Zepf,
Stefan Schellmoser,
Wolfgang Rascher, and
Helmuth G. Dörr
From the Universitätsklinik für Kinder und
Jugendliche, Erlangen, Erlagen, Germany.
Secondary hyperlipidemia is a common laboratory
finding in children with nephrotic syndrome, diabetes mellitus, and
hypothyroidism. However, clinical signs of hyperlipidemia are extremely
rare in childhood.
We report on an 11-year-old girl who presented with a disseminated
yellow papulomatous rash on the lower limbs and yellow skin creases on
the palms of her hands. Blood tests yielded an opaque serum with a
triglyceride concentration of 820 mg/dL and cholesterol of 1050 mg/dL.
Skin biopsy of one of the papules confirmed the diagnosis of xanthomas.
Additional examinations revealed clinical (weight gain, diminished
growth rate) and biochemical primary hypothyroidism (free T4: 0.4 ng/L
[normal 8-22 ng/L]; thyroid-stimulating hormone: >200 mU/L) as a
consequence of Hashimoto thyroiditis (thyroid peroxidase and
thyroglobulin: 4400 U/mL and >2000 U/mL, respectively; normal <60
U/mL). The patient was started on L-thyroxine, which led to
a gradual decline of cholesterol and triglycerides to normal concentrations and a complete remission from the xanthomatous rash.
For the first time, this case depicts disseminated xanthomas of the
skin as the presenting complaint of severe hypothyroidism. hyperlipidemia, hypothyroidism, xanthoma.
.
