Case Report
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 |
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