# Treating Severe Primary Hypothyroidism: Turning Growth Failure Into Rapidly Progressive Puberty

## TL;DR

A patient with severe hypothyroidism experienced growth failure followed by rapid puberty after treatment, highlighting the need for careful thyroid monitoring.

## Contribution

This case report documents a rare sequence of growth failure followed by puberty due to centrally driven mechanisms, not Van Wyk-Grumbach syndrome.

## Key findings

- Thyroxine replacement therapy triggered rapidly progressive puberty following growth failure in a hypothyroid patient.
- The puberty onset was centrally mediated, differing from typical Van Wyk-Grumbach syndrome cases.
- The report suggests a possible role of gonadotropin-inhibiting hormones in the observed sequence of events.

## Abstract

Growth failure and precocious or rapidly progressive puberty have been documented in several instances of untreated overt primary hypothyroidism. However, the sequential occurrence of these conditions within the same patient is less frequently observed. In this report, we present a case wherein growth failure, followed by rapidly progressive puberty, manifested following thyroxine replacement therapy. Notably, the etiology of the puberty onset in this case was centrally derived, distinguishing it from the more commonly reported Van Wyk-Grumbach syndrome. This case report provides a comprehensive summary of the aforementioned case, conducts a thorough review of relevant literature, and proposes a plausible mechanistic explanation for the observed association with gonadotropin-inhibiting hormones. The significance of maintaining vigilant thyroid function screening to detect non-specific or atypical presentations of hypothyroidism is also underscored.