title: Delayed Diagnosis of Hypothyroidism in Children: Report of 3 Cases.
abstract: BACKGROUND
  Hypothyroidism is the most common endocrine disorder in children and presented with various sign and symptoms; its diagnosis needs a high index of suspicion.
  
  
  METHODS
  We report 3 cases with unusual presentations of hypothyroidism and with delay in diagnosis that referred to Pediatric Endocrine Outpatient Clinic in Mashhad University of Medical Sciences, Mashhad, Iran with different clinical manifestations. They had decreased Thyroxin (T4) and increased thyroid stimulating hormone (TSH) levels. One case had mental retardation and deafness, but the other two cases had normal neurodevelopment. Some additional interesting findings were as follows: short stature, delayed bone age, teeth eruption impairment, hair loss, anemia and hypercholesterolemia, persistent and long-term constipation that had led to several abdominal surgeries. After a year of hormonal replacement therapy, their growth parameters and hematological values improved.
  
  
  CONCLUSIONS
  We recommend thyroid hormonal evaluation for any children with short stature, especially with delayed bone age, in order to detect and treat hypothyroidism at the right time. It seems that more attention to pediatric growth is necessary.
authors.affiliation: Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Nosrat
authors.initials: N
authors.lastname: Ghaemi
authors.affiliation: Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Bagheri
authors.affiliation: Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Saghi
authors.initials: S
authors.lastname: Elmi
authors.affiliation: Department of Pediatrics, School of Medicine, Birjand University of Medical Sciences, Birjand, IR Iran.
authors.forename: Saber
authors.initials: S
authors.lastname: Mohammadzade Rezaee
authors.affiliation: Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Sam
authors.initials: S
authors.lastname: Elmi
authors.affiliation: Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Erfani Sayyar
keywords: Bone Age; Constipation; Deafness; Hypothyroidism; Mental Retardation; Short Stature