Brown-Red Urinary Sediment as a Rare Macroscopic Finding in a 30-Month-Old Girl with Overt Hypothyroidism: A Case Report
Abstract
Hypothyroidism in children is a prevalent endocrine disorder characterized by insufficient production of thyroid hormones, significantly impacting physical growth, neurodevelopment, and metabolism. This case report presents a child exhibiting atypical manifestations. A 30-month-old (approximately 2.5 years)
girl presented with a chief complaint of brown-red particles in her urine. Initial investigations, including repeated urinalyses and abdominal-pelvic ultrasonography, yielded normal results. Importantly, repeated microscopic examinations of the urine samples revealed no crystals or abnormal cellular elements, confirming that the visible particles were purely macroscopic. Despite treatment for a suspected mild urinary tract infection, the symptom persisted. Growth parameters were within normal limits. Following consultation, thyroid function tests revealed elevated thyroid-stimulating hormone (TSH: 9.09 µIU/mL) and low total thyroxine (T4: 6.4 µg/dL), with normal anti-thyroid peroxidase antibodies, confirming a diagnosis of overt hypothyroidism. Upon diagnosis, levothyroxine therapy was initiated, leading to rapid symptom improvement and complete resolution of the urinary particles within days. This case underscores the importance of considering overt hypothyroidism in children with nonspecific urinary symptoms and highlights the
value of meticulous clinical follow-up.
org/10.1007/s40272-017-0238-0
[2] Büyükgebiz A. Newborn screening for congenital hypothyroidism. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):8-12.
[3] van Trotsenburg P, Stoupa A, Léger J, Rohrer T, Peters C, Fugazzola L, et al. Congenital hypothyroidism: a 2020-2021 consensus guidelines update-an ENDO-European reference network initiative endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology. Thyroid. 2021;31(3):387-419. https://doi.org/10.1089/thy.2020.0333
[4] Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of undertreatment of hypothyroidism. Endocrine. 2024;84(2):301-8. https://doi.org/10.1007/s12020-023-03460-1
[5] Metwalley KA, Farghaly HS. Refractory hypothyroidism in children: an overview. J Pediatr Endocrinol Metab. 2024;37(10):841-9. https://doi.org/10.1515/jpem-2024-0306
[6] Shamekhi Amiri F. Bidirectional interaction of thyroid-kidney organs in disease states. Int J Nephrol. 2020;2020(1):5248365. https://doi.org/10.1155/2020/5248365
[7] Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99(2):363-84. https://doi.org/10.1210/jc.2013-1891
[8] van Hoek I, Daminet S. Interactions between thyroid and kidney function in pathological conditions of these organ systems: a review. Gen Comp Endocrinol. 2009;160(3):205-15. https://doi.org/10.1016/j.ygcen.2008.12.008
[9] Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol. 2012;23(1):22-6. https://doi.
org/10.1681/ASN.2010070766
[10] Michael UF, Chavez R, Cookson SL, Vaamonde CA. Impaired urinary acidification in the hypothyroid rat. Pflugers Arch. 1976;361(3):215-20. https://doi.org/10.1007/BF00587285
[11] Serafini-Cessi F, Malagolini N, Cavallone D. Tamm-Horsfall glycoprotein: biology and clinical relevance. Am J Kidney
Dis. 2003;42(4)
[12] Iglesias P, Díez J. Thyroid dysfunction and kidney disease. Eur J Endocrinol. 2009;160(4):503-15. https://doi.org/10.1530/EJE-08-0837
| Files | ||
| Issue | Vol 11 No 3 (2026): May-June | |
| Section | Case Report(s) | |
| Keywords | ||
| Hypothyroidism Urinary sediment Macroscopic finding Child | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
