Severe Acquired Hypothyroidism Presenting with Growth Failure Cardiac Involvement and Anaemia in a Child

Severe hypothyroidism in childhood can present with multi-system involvement, particularly when diagnosis is delayed. This case report describes a 5-year-old girl with acquired hypothyroidism manifesting as growth failure, delayed bone age, cardiac dysfunction, and anemia. The child presented with proportionate short stature, dry skin, and bradycardia. Anthropometric evaluation revealed height and weight below age norms, with bone age delayed to approximately two years. Laboratory investigations confirmed profound hypothyroidism with thyroid-stimulating hormone (TSH) levels exceeding 100 mIU/L, markedly reduced free thyroxine, and haemoglobin of 8.5 g/dL. Radiographic assessment demonstrated severe skeletal maturation delay, while echocardiography (Echo) revealed pericardial effusion, valvular regurgitation, and reduced left ventricular ejection fraction. Electrocardiography (ECG) showed low-voltage complexes, consistent with hypothyroid-related cardiac involvement. The presence of anemia further highlighted the chronicity of disease, reflecting impaired erythropoiesis secondary to thyroid hormone deficiency. Management was initiated with low-dose levothyroxine, gradually titrated to avoid cardiac stress, without immediate hematinic or cardiacspecific therapy. Prognosis is favourable with timely treatment, with expected improvement in growth velocity, cardiac function, and haemoglobin levels. However, delayed intervention risks permanent growth impairment and persistent cardiac dysfunction. This case underscores the importance of thyroid evaluation in children presenting with short stature, anemia, and unexplained cardiac findings, emphasizing early recognition to prevent long-term sequelae. Keywords: Hypothyroidism, child, cardiomyopathy, anaemia, growth failure