Sexual precocity in a girl with early-onset Graves’ disease

While delayed pubertal onset is generally observed in children with hypothyroidism, the effect of thyrotoxicosis on pubertal development has not been well defined. Accelerated growth and bone maturation are often described features of childhood-onset Graves’ disease (GD) (1,2,3,4,5,6), and therefore, thyroid hormone excess may accelerate the tempo of somatic growth leading to early pubertal onset. However, growth rate usually attenuates after euthyroidism is achieved with anti-thyroid treatment (1,2,3). Consequently, the timing of pubertal onset and menarche are not influenced, and adult stature is not impaired (2,3,4). Thus, the growth acceleration and skeletal maturation at disease onset do not seem to influence the timing of puberty, and early pubertal development in girls with GD appears to be rare. Here, we report the case of a girl with GD onset at 2 yr of age, who developed early puberty at 6 yr. After gonadal suppression therapy, her adult height was slightly taller than her target height.