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.
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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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