J Korean Med Sci.  2020 Jun;35(22):e180. 10.3346/jkms.2020.35.e180.

A Case of Consumptive Hypothyroidism in a 1-Month-Old Boy with Diffuse Infantile Hepatic Hemangiomas

• Kim YH
• Lee YA
• Shin CH
• Hong KT
• Kim GB
• Ko JS
• Lee YJ

• KMID: 2502609
• DOI: http://doi.org/10.3346/jkms.2020.35.e180

Abstract

Consumptive hypothyroidism is a rare paraneoplastic syndrome characterized by excessive inactivation of the thyroid hormones due to increased type 3 iodothyronine deiodinase activity of tumors. We report the case of severe consumptive hypothyroidism in a 1-month-old boy with infantile hepatic hemangiomas who presented with cardiac failure and cholestasis. Diffuse infiltration of hepatic hemangiomas was detected on abdominal imaging studies, and thyroid function screening test revealed severe hypothyroidism, which necessitated the administration of higher-than-usual doses of levothyroxine for the normalization of thyroid function. The patient was successfully treated with propranolol, prednisolone, and levothyroxine, and he showed normal thyroid function at 3 months of age and normal neurodevelopment at 9 months of age. This case highlights the importance of early recognition and prompt management of consumptive hypothyroidism in patients with infantile hepatic hemangiomas.

Keyword

Hypothyroidism; Infantile Hepatic Hemangioma; Iodothyronine Deiodinase Type 3

Figure

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  Fig. 1 Liver magnetic resonance imaging findings at initial presentation showing multiple nodular lesions with T2 intermediate-high signal intensity and filling enhancement pattern in the liver parenchyma, (A) coronal view, (B) axial view. The images are published under agreement of the patient's parents.

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  Fig. 2 Changes in thyroid function over time according to treatment course.TSH = thyroid-stimulating hormone, fT4 = free thyroxine, fT3 = free triiodothyronine.*Initial thyroid function test showed TSH level over 500 μIU/mL.

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