A 5-year-old girl presented with a 3-month history of yellow skin pigmentation of the skin and fatigue. She had no significant past medical history. On examination, the yellow pigmentation was generalised, especially on the palms and soles (figure 1), with normal sclerae. Her growth had recently slowed ( + 0.9cm/4 months). She and her twin ate one to two tangerines a day but not carrots; additionally, her sister did not develop yellow skin coloration. Her serum bilirubin level was normal, but her serum P-carotene level was elevated (126.9 ng/mL; reference, 20.4105.2 ng/mL). Furthermore, she had hypothyroidism with elevated thyroid-stimulating hormone (82.4 mIU/L) and decreased free thyroxine (10.2 pmol/L) levels. She was diagnosed with Hashimoto’s thyroiditis based on positive anti-thyroid peroxidase and anti-thyroglobulin antibodies, and diffuse thyroid enlargement on ultrasonography. Treatment with levothyroxine sodium improved her energy levels and skin appearances and serum P-carotene levels normalised to 46.2ng/mL within 3 months (figure 2). Her height velocity also improved (+4.6 cm/4 months).
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