Hypothyroidism masked by crystalluria: an unusual sign predicting growth failure - A case report

Background: Introduction: Hypothyroidism in children is a prevalent endocrine disorder characterized by insufficient production of thyroid hormones. This condition significantly impacts physical growth, neurodevelopment, and metabolic function in children. This study presents a case of a child exhibiting atypical manifestations of the disease Case presentation: The patient presented with a chief complaint of brown-red particles in the urine. Initial investigations included repeated urine tests and abdominal and pelvic ultrasounds, all of which returned normal results. Despite treatment for a mild urinary tract infection, the patient's symptoms persisted. Notably, the patient's growth parameters (height and weight) were within normal limits. Following consultation with the mother, who is a nurse, thyroid tests were conducted, revealing an elevated TSH level (9.09 µIU/ml) and a decreased total T4 level (6.4 µIU/ml). Anti-thyroid antibodies (Anti-TPO) were reported to be within the normal range. After the diagnosis of hypothyroidism, treatment with levothyroxine was initiated by a specialist physician, resulting in a rapid improvement of symptoms and the elimination of urinary particles within a few days. Conclusion: This study emphasizes the importance of paying attention to nonspecific manifestations of hypothyroidism in children and the value of careful clinical follow-up.