Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
Department of Pediatric Emergency, Regina Margherita Children's Hospital, AOU Città Della Salute E Della Scienza, Turin, Italy.
Ital J Pediatr. 2022 Sep 11;48(1):171. doi: 10.1186/s13052-022-01363-x.
The relative high frequency of menstrual irregularities in the first two-three years after menarche may lead to the risk of underestimation of associated pathological conditions, which are always to be accurately researched with careful examination and anamnesis. The association between menstrual irregularities and hypothyroidism is described in literature but the available data are scarce and mainly based on adult case series. It is described that low plasma levels of thyroid hormone can shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state and seem to lead to an increased bleeding risk.
This case report describes the case of a thirteen years old girl who presented to our Emergency Department complaining of menorrhagia for the last fifteen days, leading to severe anemia. The objective examination revealed clinical signs of hypothyroidism and a severe short stature, lower than mid-parental height, with stunting of growth and a significant bone age delay. Blood exams and thyroid ultrasound were consistent with the diagnosis of severe hypothyroidism in autoimmune thyroiditis with acquired von Willebrand syndrome, growth hormone deficiency. Magnetic resonance showed pituitary functional hyperplasia. The substitutive therapy with levothyroxine led to the resolution of heavy bleeding after five days and following normalization of coagulative parameters and pituitary hyperplasia.
Hypothyroidism usually presents with unspecific symptoms, with consequent risk of diagnostic delay. It can influence the coagulation system and it seems to be associated to increased risk of menstrual irregularities. We underline the importance of a regular follow up of the pubertal development, including height measurements, thyroid palpation and menstrual anamnesis to intercept red flags findings for hypothyroidism.
初潮后前两三年月经不规律的相对高发可能导致相关病理状况的低估风险，这些状况总是需要通过仔细检查和病史调查来准确研究。文献中描述了月经不规律与甲状腺功能减退症之间的关联，但现有数据稀缺，主要基于成人病例系列。据描述，甲状腺激素的低血浆水平可使止血系统向低凝和高纤维蛋白溶解状态转移，似乎导致出血风险增加。
本病例报告描述了一名 13 岁女孩的病例，她因月经出血过多在过去 15 天来我院急诊就诊，导致严重贫血。体格检查显示出甲状腺功能减退的临床体征和严重的身材矮小，低于中亲身高，生长发育迟缓，骨龄明显延迟。血液检查和甲状腺超声检查与自身免疫性甲状腺炎伴获得性血管性血友病、生长激素缺乏症的严重甲状腺功能减退症的诊断一致。磁共振显示垂体功能增生。左甲状腺素替代治疗 5 天后，大量出血得到缓解，凝血参数和垂体增生随之恢复正常。
甲状腺功能减退症通常表现为非特异性症状，因此存在诊断延迟的风险。它可能会影响凝血系统，并且似乎与月经不规律的风险增加有关。我们强调了定期随访青春期发育的重要性，包括身高测量、甲状腺触诊和月经病史，以发现甲状腺功能减退症的潜在风险因素。
