Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism

Background

Severe pediatric hypothyroidism is a relatively rare endocrine disorder characterized by inadequate thyroid hormone production or action in children. It can have significant effects on various organ systems, including the gastrointestinal (GI) tract, and cause upper GI bleeding (UGIB). It can be challenging to diagnose as the cause in the emergency department (ED).

Case report

We present the case of a 13-year-old previously healthy male presenting with hematemesis as the chief complaint to the pediatric emergency department, who was subsequently found to have severe hypothyroidism based on a constellation of vital sign abnormalities in the absence of other likely etiologies. This case illustrates the importance of considering endocrinopathies as part of the overall differential diagnoses for a pediatric patient presenting with isolated hematemesis, especially if there is a disparity between vital signs and other clinical signs.

Why should an emergency physician be aware of this?

Recognizing pediatric hypothyroidism as a potential cause of UGIB presents a particular diagnostic challenge for emergency physicians. Symptoms of pediatric hypothyroidism can be varied, and UGIB in this setting is a rare and poorly understood clinical entity. Timely diagnosis and treatment of hypothyroidism are crucial to prevent further complications and optimize the child's growth and development.