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Letters to the Editor

Indian Pediatrics 2001; 38: 1431-1432

Isolated Menarche and Multicystic Ovaries in a 7½-year- Girl with Hypothyroidism


We read with interest the recent paper on this subject(1). We congratulate the authors for detecting a rare presentation of primary hypothyroidism. The authors have mentioned that there was isolated menarche and prepubertal response to LHRH test. Though the article was informative for pediatricians, certain points need attention:

(a) The authors have mentioned that patient had isolated menarche, but at the same time they also mentioned breast at B2 stage. So the appropriate title should be "Isosexual precosity and multicystic ovaries in a 7½-year-girl with hypo-thyroidism" in place of "Isolated menarche and multicystic ovaries in a 7½- year-girl with hypothyroidism".

(b) The authors have not mentioned the exact levels of LH, FSH, E2 (total and free) and TeBG. This is important because pubertal development is closely related with E2 level. In hypothyroidism the level of TeBG and binding activity of TeBG is low and thus even if total E2 is normal or low, the free E2 may be high(2). LH is usually low, but FSH may be high.

(c) Though the authors have discussed the reasons for sexual precosity, the other possible reasons for sexual precosity in hypothyroidism include (i) increased sensitivity of mammotropes and gonado-tropes to TRH; and (ii) hypothyroidism causing hypothalamic encephalopathy that impairs the normal tonic suppres- sion of gonadotropin relase by the hypothalamus(3).

S.K. Singh,
Rina Singh,
V.K. Maurya,

Diabetic and Endocrine Center,
and Koshika Children Hospital,
Varanasi, India.


Correspondence to:
Dr. S.K. Singh,
Plot No. 35, Raj Rajeshwari Nagar Colony,
Gilat Bazar, Varanasi 221 002, India.

 

 References


1. Dhanwal D, Tandon N, Isolated menarche and multicystic ovaries in a 7½ year girl with hypothyroidism. Indian Pediatr 2001; 38: 332-333.

2. Gordon GG, Southern AL. Thyroid hormone effects on steroid-hormone metabolism. Bull NY Acad Med 1977; 53: 241-259.

3. Reichlin S. Neuroendocrinology. In: William’s Textbook of Endocrinology, 9th edn. Eds. Wilson JD, Foster DW, W.B. Saunders Company, 1998; pp 165-248.

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