Abstract
We report the case of a 23-month-old girl who presented with poor growth and delayed attainment of gross-motor milestones. Elevated creatine phosphokinase (CPK) indicated rhabdomyolysis, ultimately attributed to severe, acquired autoimmune hypothyroidism. Growth data and bone-age suggest the onset of hypothyroidism occurred at or before 12 months of age. Acquired hypothyroidism is rare before age 3 years, and rhabdomyolysis due to hypothyroidism has not previously been reported as a cause of delayed gross-motor development in toddlerhood. Despite the early onset of hypothyroidism, cognitive function appeared to be unaffected. Adequate thyroid hormone replacement quickly normalized the CPK in our patient, and gross motor development rapidly improved. Although rare, rhabdomyolysis secondary to hypothyroidism should be in the differential diagnosis of delayed gross-motor development in infancy and toddlerhood.
Similar content being viewed by others
References
Altay M, Duranay M, Ceri M (2005) Rhabdomyolysis due to hypothyroidism. Nephrology Dial Transplant 20:847–848
Barahona MJ, Mauri A, Sucunza N, Paredes R, Wagner AM (2002) Hypothyroidism as a cause of rhabdomyolysis. Endocr J 49:621–623
Bonger-Schokking JJ, Koot HM, Wiersma D, Verkerk PH, de Muninck Keiser-Schrama SMPF (2000) Influence of timing and dose of thyroid hormone replacement on development in infants with congenital hypothyroidism. J Pediatr 136:292–297
Cakir M, Mahsereci E, Altunbas H, Karayalcin U (2005) A case of rhabdomyolysis associated with thyrotoxicosis. J Natl Med Assoc 97:732–734
Cao A, De Virgilliis S, Trabalza N, Furbetta M (1971) Serum creatinine phosphokinase isoenzymes in congenital hypothyroidism. J Pediatr 78:134–135
Fisher DA (2000) The importance of early management in optimizing IQ in infants with congenital hypothyroidism. J Pediatr 136:273–274
Foley TP, Abbassi V, Copeland KC, Draznin MB (1994) Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. New Engl J Med 330:466–468
Kaino Y, Otoh Y, Tokuda K, Hirai H, Ito T, Kida K (2000) Acquired hypothyroidism in a very young infant with Omenn’s syndrome. J Pediatr 136:111–113
Kisakol G, Tunc R, Kaya A (2003) Rhabdomyolysis in a patient with hypothyroidism. Endocr J 50:221–223
Ostergaard GZ, Jacobsen BB (1989) Atrophic, autoimmune thyroiditis in infancy. Horm Res 31:190–192
Powell BR, Bruist NRM, Stenzel P (1982) An X-linked syndrome of diarrhea, polyendocrinopathy, and fatal infection in infancy. J Pediatr 100:731–737
Savage MO, Mirakian R, Wozniak ER (1985) Specific autoantibodies to gut epithelium in two infants with severe protracted diarrhoea. J Pediatr Gastroenterol Nutr 4:187–195
Scott KR, Simmons Z, Boyer PJ (2002) Hypothyroid myopathy with a strikingly elevated serum creatine kinase level. Muscle Nerve 26:141–144
Williams H, Hughes I, Harper PS, Bradley D (1984) False positive creatinine kinase test in a hypothyroid male at risk for duchenne muscular dystrophy. Lancet 323:645–646
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gunther, D.F., Chiu, H.K., Numrych, T.E. et al. Onset of acquired autoimmune hypothyroidism in infancy: a presentation of delayed gross-motor development and rhabdomyolysis. Eur J Pediatr 165, 320–322 (2006). https://doi.org/10.1007/s00431-005-0051-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-005-0051-6