Acquired Hypothyroidism Masquerading As Post Hepatitis Sequelae in a Moderate Acute Malnutrition Child

OBJECTIVES: The thyroid hormone influences the physiological process of almost all organ systems in children .It is essential for modulation of cardiovascular, neurological, gastrointestinal and metabolic function. In children at the early ages, it influences growth, physical and neurological development. As it is a preventable cause of intellectual disability, prompt recognition and treatment of hypothyroidism is integral to optimize physical and neurodevelopmental outcome. METHODS: A 5 year 6 months old female child presented with history of 5 days of abdominal distension, fever and 1 episode of bloody stools. Examination showed icterus and bilateral pedal edema. Liver function test was deranged. Triglycerides and total cholesterol were elevated. Hepatitis serologies were negative. As there was no clinical improvement paediatric thyroid profile was requested which showed low T4 and significantly elevated TSH of 100 uIU/ml. Thyroid ultrasound was suggestive of thyroiditis .Anti-TPO antibodies were elevated. Treatment for Hashimoto's thyroiditis was initiated. Oral thyroxine was started at the dose of 5mcg/kg/day. The child improved symptomatically and icterus resolved. On follow up, her weight for height plotted was between −2 and −3 standard deviations and classified as moderate acute malnutrition. Diet counselling and nutritional supplements was initiated. RESULTS: Autoimmune thyroiditis is the most common cause of acquired hypothyroidism. Studies have shown thyroiditis to be linked with genetic loci such as CTLA-4, PTPN22. A goitre may not be present due to rapid immune-mediated destruction of the gland. Thyroid ultrasound is usually diagnostic. This child presented with jaundice, edema and abdominal distension. A post hepatitis sequelae was suspected but all serum markers were negative. Subsequently, hypothyroidism was diagnosed. On follow up, child was labelled as moderate acute malnutrition. This child is at risk for severe malnutrition; supplementary feeding and monitoring of growth curves should be done to ensure proper growth and development of the child. CONCLUSIONS: Childhood malnutrition is a public health crisis and a major cause of mortality under five years of age. Prevention of severe malnutrition is a global health goal. In a country like India, health programmes should focus on maternal and child malnutrition. FUNDING SOURCES: None.