Anemia, growth failure and hypothyroidism

A 12-year-old Caucasian female presented to her family physician with an old complaint of anemia and a new complaint of failure to grow. The anemia, first observed four years previously, had been diagnosed as iron deficiency, but had never satisfactorily responded to adequate iron therapy. Investigation of the failure to grow resulted in a diagnosis of hypothyroidism with related normochromic normocytic anemia.This case serves to review the rather complicated relationship between hypothyroidism and the three types of anemia. The case report also reminds family physicians of several diagnostic principles: the importance of knowing stages in the evolution of disease; the importance of time and repeated contact with patients; the importance of diagnostic pathways and investigation of symptoms, and after diagnosis is established, the importance of ongoing monitoring of the patient.