Severe Hypothyroidism and Large Goiter due to Iodine Deficiency in an Adolescent Male in the United States: A Case Report and Review of the Literature

Table 1

Reported cases of dietary restriction causing iodine deficiency hypothyroidism.

	Kanaka et al. 1992 [7]	Leniszewski et al. 2009 [8]	BrooksMJ et al. 2014 [9]	Cheetham et al. 2015 [10]	Booms et al. 2016 [11]		Yeliosof et al. 2018 [12]	Our patient
					Case 1	Case 2
Age at diagnosis	7.5 months	12 years	9 years	4 years	5 years	2 years	23 months	13 y
Cause of dietary restriction	Developmental delay, hypotonia, and vegan diet	Autism, multiple food allergies	Eosinophilic esophagitis and food allergies	Multiple food allergies	Autism, gluten, and casein free diet	Picky eater and dairy-free diet due to eczema	Strict vegan diet	Autism
Physical examination	Goiter	Goiter	Goiter	Goiter	Goiter	Normal thyroid gland	Goiter	Goiter
TSH (µIU/mL)	378 (0.3–4)	16.5 (0.5–4.5)	150.4 (0.6–4.84)	9.1 (0.3–4.7)	355 (0.47–4.53)	222.43 (0.30–5.50)	382 (0.7–5.9)	416 (0.35–5.50)
Free T4 (ng/dl)	0.2253 (0.77–2)	0.2 (0.8–2)	0.18 (0.9–1.68)	0.4894 (0.74–1.63)	0.18 (0.84–2.26)	0.24 (0.76–1.70)	<0.2 (0.85–1.75)	<0.1 (0.8–1.8)
Total T4 (ug/dl)		1.6 (4.5–10)					<0.5 (4.5–12)
Free T3 (ng/dl)	0.4883 (0.20–0.55)	0.48 (0.34–0.48)			0.253 (0.2–0.5)
Total T3 (ng/dl)							59(83–230)	41 (81–213)
TPO antibodies	Negative	Negative	Negative		Negative	Negative	Negative	Negative
Tg antibodies	Negative	Negative	Negative		Negative	Negative	Negative	Negative
Urine iodine (µg/L)	3.03 (6.58–42.66)	<10 (100–460)	—	10.1 (50–240)	11 (100–199)	20 (100–199)	—	<5 (26–705)
Thyroid ultrasound	—	Right lobe 7.4 × 4.0 × 2.6 cm, total volume 41 cc. Left lobe 7.8 × 3.2 × 2.9 cm, total volume 38 cc	Simple goiter	Thyroid gland enlargement with hypervascularity on doppler	Enlarged hyperemic gland, suggesting Hashimoto’s thyroiditis	—	Right lobe −1.5 × 1.7 × 3.3 cm, left lobe 1.2 × 1.1 × 2.4 cm	Right lobe 8.3 × 3.7 × 4.6 cm. Left lobe 8.6 × 3.2 × 4.5 cm. Heterogeneous in echotexture with a lobular contour and diffuse hyperemia