A child with three rare presentations of a common disease

Autoimmune thyroiditis (Hashimoto thyroiditis) is the commonest thyroid disorder in childhood. It is associated with antibodies against thyroglobulin and thyroperoxidase with lymphocytic infiltration in the thyroid tissue. It may be associated with primary hypothyroidism, transient hyperthyroidism or an euthyroid state. It typically affects females-5 times more commonly than males. We aim to describe three rare presentations of a common disease (Hashimoto thyroiditis) in the same child and to discuss its clinical course and response to L-Thyroxin replacement during two years of treatment. We report an eleven years six months old female child, with severe long standing acquired primary hypothyroidism due to Hashimoto thyroiditis, who had, in addition to the typical hypothyroidism symptoms, three rare presentations at the same time including Hashimoto encephalopathy, gonadotropin independent precocious puberty and pituitary adenoma. She was treated with L-Thyroxin only with significant improvement and regression of her symptoms.