{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T01:12:17Z","timestamp":1780103537559,"version":"3.54.0"},"reference-count":18,"publisher":"Walter de Gruyter GmbH","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,26]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"j_jpem-2018-0055_s_999_w2aab3b7c53b1b6b1aab1c16b1Aa\"><jats:title>Background<\/jats:title><jats:p>Infantile hepatic haemangiomas (IHHs) produce an excess of the thyroid hormone inactivating enzyme type-3 iodothyronine deiodinase (D3), leading to rapid degradation of thyroid hormones and consumptive hypothyroidism. The L-thyroxine replacement dose in patients with consumptive hypothyroidism is inappropriately higher than that in congenital hypothyroidism.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0055_s_998_w2aab3b7c53b1b6b1aab1c16b2Aa\"><jats:title>Case presentation<\/jats:title><jats:p>A 4-month-old boy presented with abdominal distention. Thyroid function tests (TFTs) revealed an elevated thyroid-stimulating hormone (TSH) level of 177 mU\/L, normal free thyroxine (fT4) of 1.23 ng\/dL, low free tri-iodothyronine (fT3) of 1.55 pg\/mL and increased reverse T3 (rT3) of 1240 ng\/dL. Abdominal ultrasound and magnetic resonance imaging (MRI) revealed multiple IHHs. Based on his TFTs, ultrasonography and MRI evidence, he was diagnosed with consumptive hypothyroidism, and L-thyroxine replacement at 15 \u03bcg\/kg\/day was started. The L-thyroxine dose was increased gradually to 35 \u03bc\/kg\/day until a stabilising euthyroid status was achieved. By the age of 8 months, the TSH concentration was decreased to normal levels; the L-thyroxine dose was gradually reduced and finally discontinued at the age of 12 months. Repeat abdominal ultrasound and MRI revealed a reduction in the number and size of the haemangiomas. The TFTs were at normal reference levels. The patient remains in active follow-up.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0055_s_997_w2aab3b7c53b1b6b1aab1c16b3Aa\"><jats:title>Conclusions<\/jats:title><jats:p>Neonatal screening for congenital hypothyroidism is usually negative in cases of IHH, as seen in our case. A high index of suspicion is necessary to diagnose hypothyroidism in cases of IHH. The present case required very high doses of levothyroxine to achieve a euthyroid status. In cases of hypothyroidism in the first year of life with consumptive hypothyroidism caused by hepatic haemangioma, aggressive L-thyroxine replacement is required with no upper limit. The dose should be increased gradually until a stabilising euthyroid status is achieved.<\/jats:p><\/jats:sec>","DOI":"10.1515\/jpem-2018-0055","type":"journal-article","created":{"date-parts":[[2018,7,13]],"date-time":"2018-07-13T01:31:55Z","timestamp":1531445515000},"page":"823-827","source":"Crossref","is-referenced-by-count":17,"title":["Severe consumptive hypothyroidism caused by multiple infantile hepatic haemangiomas"],"prefix":"10.1515","volume":"31","author":[{"given":"Enver","family":"Simsek","sequence":"first","affiliation":[{"name":"Eskisehir Osmangazi University, School of Medicine , Department of Pediatric, Division of Pediatric Endocrinology , Meselik, Eskisehir , Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meliha","family":"Demiral","sequence":"additional","affiliation":[{"name":"Eskisehir Osmangazi University, School of Medicine , Department of Pediatric, Division of Pediatric Endocrinology , Meselik, Eskisehir , Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif","family":"Gundo\u011fdu","sequence":"additional","affiliation":[{"name":"Eskisehir Osmangazi University, School of Medicine, Department of Radiology , Meselik, Eskisehir , Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2018,6,28]]},"reference":[{"key":"2023040100083372798_j_jpem-2018-0055_ref_001_w2aab3b7c53b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"Itinteang T, Withers AH, Davis PF, Tan ST. 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