How does hypothyroidism affect development?

Question:

Hello,

I am 19 years old. I have CDGP. There is neither extreme deficiency nor an incomplete adolescence. I have been going to endocrinology since I was 14 years old, and my TSH level has always been around 9.5 since I was 14 years old. They always told me to change my lifestyle and exercise, but I didn’t pay much attention. When I turned 18, I lost weight and although my weight dropped to normal BMI, my TSH level was still around 9.5-10. After a TRH test was performed, I was diagnosed with primary hypothyroidism, I started using euthyrox. My hypothyroidism was left untreated throughout adolescence, and I suffered severe effects. My complaint is as follows: I am 19 years old, but my physical characteristics are the same as when I was 15-16 years old when I had just entered puberty. I remain like a 15 to 16-year-old child among my average standard peers, and I think that my secondary sexual characteristics are not like those of my normal age.

1. My voice is not like a child, but like someone who has just entered puberty. I have a high-pitched voice and it has not deepened like a normal male.
2. My height and penis increased in length, but during puberty, my body did not expand in width as much as a typical adult male. It has remained almost the same as it was in childhood and early adolescence. To give an example, I have 15.5 cm wrists My wrist bone has been almost the same thickness since I was 14 years old and even my mother’s wrists are thicker. My body structure, the width of my shoulders, the size of my shoulders, and my face structure remained like a 15 to 16-year-old teenager.
3. My entire lineage does not have a problem with facial or boy hair, on the contrary, they have a lot of it. I have blond hair that covers all the beard lines on my face since I was 15-16 years old, but despite everything, it never turns into a terminal beard or vellus. Even on the lips, there is nothing we can call a mustache. It has such short fur that it cannot be seen unless approached, it does not grow at all, and it has very little dark fur.
4. A testicular ultrasound was performed and he said it was close to but not at adult size. The right volume was measured as 12.26 ml and the left volume was 13.82 ml. When combined with my other features, my doctor said that Tanner Stage 4 was still not over and that there were no extreme deficiencies, but that I was not at full adult size.
5. My penis length is average, but after reaching 14-15 years old, it did not expand in width like other men whom I know. My penis remained like someone in mid-adolescence, not an adult.
6. There is dense hair in the triangular part of the pubic area, but there is no hair on the inner parts of the thigh, it is smooth and the hair in the pubic area does not extend to the belly button hair. There are light-dark hairs extending from the navel area to the middle of the abdomen, but there is not a single hair on my chest. My father has all of these, including the beard, and they all happened during adolescence and were completed when he was 17-18 years old. I wrote about this hair growth in detail because it is said to be a symptom of the Tanner stages. I have armpit hair.
7. My doctor said that I noticed a mass during the physical examination and that it could be gynecomastia. A breast ultrasound was performed and they said it was probably pseudo-gynecomastia, but they said it was not certain and the real situation would become clear after losing weight.
8. Since my body did not expand in width, I had a lot of stretch marks everywhere on my arms, legs, abdomen, and shoulders. I am the same weight and height as my father, but my father is wider in width and there are no stretch marks, and I have not gained weight suddenly. When I was 14-15 years old and just entered puberty, I had stretch marks. Even the doctor was surprised and said they shouldn’t have happened.

My doctor and the Tanner calculator are not wrong, are they? These fit Tanner’s stage 4, right? How can untreated hypothyroidism cause this condition? After this age, is it possible for me to expand my testicular volume, penis thickness, and body structure, complete the Tanner stages, and be like a normal peer? The hospital I went to and my doctor are among the best doctors in this field. They discussed my issue at a medical council.

Answer:

CGDP (constitutional delay in growth and puberty) is a fancy of way saying that you are a late bloomer because of how your body functions. In your case, your thyroid is not operating properly and not producing enough hormones. Your thyroid produces hormones critical for regulating your body’s growth. Normal TSH levels are between 0.4 and 4.0 mIU/L. Between 2.0 and 4.0 is considered a warning sign that hypothyroidism might develop later. Your level should have been treated immediately.

It sounds like you’ve reached Tanner Stage 3 and then stalled. The stretch marks are due to your skin growing rapidly enough to cover your larger body. The characteristics that you mention lacking are the ones that develop in stage 4. Your testicle size is also for late stage 3 or early stage 4.

Once hypothyroidism is treated, it is common for people to rapidly catch up to where they ought to have been. However, if treatment is delayed too long, the body can reach a point where it cannot grow even though the problem inhibiting growth has been removed. Also, while there is catch-up growth, it rarely reaches the full growth potential of someone without hypothyroidism.