title: Difficult treatment of consumptive hypothyroidism in a child with massive parotid hemangioma.
abstract: Consumptive hypothyroidism is a rare condition related to massive infantile hemangiomas producing an excess of the thyroid-hormone-inactivating enzyme type 3 iodothyronine deiodinase. We report the first case of consumptive hypothyroidism secondary to a large parotid hemangioma, highlighting the difficulties in selecting an adequate therapeutic strategy. The affected child was initially referred to our center for congenital hypothyroidism with a hypoplastic thyroid gland. L-Thyroxine (L-T4) replacement therapy was started at seven days of life. In the following weeks, the hemangioma rapidly increased in volume and the child developed severe hypothyroidism refractory to high doses of L-T4 therapy. The concentration of reverse triiodothyronine was elevated, suggesting that the underlying cause was an excessive conversion of thyroid hormones by high type 3 iodothyronine deiodinase levels in the tumor. Corticosteroid treatment showed only partial benefit. Introduction of propranolol instead led to normalization of thyroid hormones along with a dramatic involution of the hemangioma.
authors.affiliation: Department of Pediatrics, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vigone
authors.forename: Francesca
authors.initials: F
authors.lastname: Cortinovis
authors.forename: Sarah
authors.initials: S
authors.lastname: Rabbiosi
authors.forename: Marianna
authors.initials: M
authors.lastname: Di Frenna
authors.forename: Arianna
authors.initials: A
authors.lastname: Passoni
authors.forename: Luca
authors.initials: L
authors.lastname: Persani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiumello
authors.forename: Carlo
authors.initials: C
authors.lastname: Gelmetti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Weber
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D003409:Congenital Hypothyroidism / Q000188:drug therapy; D005260:Female; D006391:Hemangioma / Q000150:complications*; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D010307:Parotid Neoplasms / Q000150:complications*; D011433:Propranolol / Q000627:therapeutic use; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D011433:Propranolol; D013974:Thyroxine