Successful Combined Treatment for Atrophic Thyroiditis With Growth Hormone Deficiency.

Abstract

Persons with untreated atrophic thyroiditis develop a permanent height deficit. Adequate thyroxine replacement therapy can improve growth and the probability of attaining normal adult height. However, height deficit is related to duration of thyroxine deficiency, regardless of the adequacy of thyroxine replacement therapy after diagnosis.1 Several studies reported that use of adjunctive therapy with growth hormone (GH) and gonadotropin-releasing hormone agonist (GnRHa) to improve the final height of patients.2-5 The rationale for this therapy is to prolong the growth period by inhibiting pubertal progression and delaying epiphyseal fusion,6 although GH deficiency in atrophic thyroiditis patients usually improves after L-thyroxine treatment. We report a case of autoimmune atrophic thyroiditis in a boy who presented with GH deficiency even after his enlarged pituitary gland had decreased in size. Combined treatment with GH, GnRHa, and L-thyroxine was successful in allowing the patient to attain normal adult height.