title: Congenital hypothyroidism - An usual suspect at an unusual age: A case series.
abstract: Menorrhagia is the most common menstrual irregularity in hypothyroid women. However, it is an uncommon presentation of congenital hypothyroidism (CH). In the era of newborn screening across the world, when CH is extremely rare, we came across four cases of CH due to delayed diagnosis, presenting in adulthood with severe menorrhagia.
  
  
  OBJECTIVE
  To signify the atypical presentation of CH in late adulthood due to delayed diagnosis and its sequelae; and to increase the awareness about this treatable condition.
  
  
  METHODS
  This is a cross-sectional analysis of consecutive patients with CH presenting after 18 years between 2010 and 2012 from the CH registry of Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India.
  
  
  METHODS
  Four patients of CH presenting late (>18 years) with atypical presentations out of total 16 cases of CH within a period of 3 years were analyzed for clinical, hormonal, and imaging findings.
  
  
  RESULTS
  Between the years 2010 and 2012, 16 cases of CH were registered at our center out of which four cases presented in late adolescence and adulthood with menorrhagia. Age range of these patients was 18-30 years. All four patients were females presenting with anemia secondary to menorrhagia and upon evaluation were found to have CH. All of them showed improvement after starting treatment and are currently doing well with regular menstrual cycles.
  
  
  CONCLUSIONS
  Our study demonstrates the importance of thyroid evaluation in a patient presenting with menorrhagia along with short stature. There is need for awareness among clinicians regarding the clinical features of CH and nationwide screening for CH in our country.
authors.affiliation: Department of Endocrinology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Suja P
authors.initials: SP
authors.lastname: Sukumar
authors.forename: Karthik
authors.initials: K
authors.lastname: Balachandran
authors.lastname: Jayakumar
authors.forename: Sadishkumar
authors.initials: S
authors.lastname: Kamalanathan
authors.forename: Jaya Prakash
authors.initials: JP
authors.lastname: Sahoo
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Das
authors.forename: Dhanapathi
authors.initials: D
authors.lastname: Halanaik
keywords: Congenital hypothyroidism; menorrhagia; neonatal screening; short stature; thyroid dysgenesis