Author: Joshua Alexander, MD
History:
Tony's mother brought him to see the doctor because she was worried that he had "stopped growing".
Tony was a 5 and ? year old boy who had been in an automobile accident two years ago. In the accident, he suffered a severe head injury with a right sided skull fracture, a right sided brain contusion, a basilar skull fracture (fracture at the base of the skull), and a left thigh fracture. He was taking Tegretol? (Carbamazepine) for a seizure disorder and was receiving therapy services for left sided muscle weakness and difficulty speaking. His mother felt that, although he'd been gaining weight well, he had gone from being taller than his classmates to being shorter than most of them. She reported that he ate appropriate amounts of food and had a well balanced diet.
A review of his growth chart confirmed his mother's impression that, while his weight had continued to increase as it should, his increase in height had not kept pace. While he was at the 75th percentile height for age before the accident, he was only 25th percentile for age last year and was now hovering at the 5th percentile.
Blood tests were performed to examine his thyroid function and his body's cortisol and growth hormone levels and their results provided a reason for Tony's lack of growth.
While his cortisol level was normal, his growth hormone level was low normal and his active thyroid hormone levels were abnormally low.
He was diagnosed with hypothyroidism (low levels of thyroid hormone in the blood) and started on Synthroid? (Levothyroxine), a thyroid hormone replacement. His growth was monitored and, after a year, his height had increased several inches. His doctor and his mother decided to keep him on the Synthroid and continue to monitor his growth together.
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