Primary hypothyroidism presenting as severe vaginal bleeding in a prepubertal girl

We describe a case of acquired primary hypothyroidism in a prepubertal girl who presented with profound bradycardia, precocious puberty, and severe vaginal bleeding. A pelvic ultrasound revealed markedly enlarged ovaries with numerous cysts. Cystic aspiration, in concert with L-thyroxine therapy, appeared to halt vaginal bleeding, and led to resolution of cysts. This is the first reported case of percutaneous cyst aspiration to treat ovarian hyperstimulation caused by hypothyroidism in a child.