During skeletal development, bone formation occurs via two distinct processes. The flat bones of the skull vault and pelvis, together with the lateral third of the clavicle, form by intramembranous ossification in which mesenchymal progenitor cells condense and differentiate directly into osteoblasts. Long bones and vertebrae, by contrast, form on an intermediary cartilage template by endochondral ossification after mesenchyme precursors differentiate to chondrocytes. Thyroid hormones have important effects on skeletal development, linear growth and the maintenance of adult bone mass and strength. Hypothyroidism in childhood is relatively common. Hypothyroidism results in delayed skeletal development, growth retardation and short stature with impaired bone maturation due to defective endochondral ossification. Impaired intramembranous ossification results in delayed closure of the fontanelles, persistently patent skull sutures and a typically flat nasal bridge and broad face. In severe undiagnosed cases, there will be complete post-natal growth arrest and skeletal dysplasia. We report a case of 6 year boy brought with complaints of not gaining height, bloating of abdomen, constipation, developmental delay from 1 year. Suspecting hypothyroidism child was evaluated. Both clinical and biochemical features matched confirming Hypothyroidism. He was initiated on 3-4mcg/kg dose of levothyroxine with which his complaints have improved and started to gain height. My intention to present this case is to throw light on clinical and radiographic features of hypothyroidism on bone. 

Dr. Kavya. Jonnalagadda has completed her DM in Endocrinology at the age of 29 years from Amrita Viswavidyapeetham, Amrita Institute of Medical Sciences, Kochi, India. She is the Consultant Endocrinologist at Sree Charith Hospitals and Gayathri Hospitals, Tirupati, India. She has both National and International publications to her own credit. She is a member of Indian Medical Association, Research Society for the Study of Diabetes in India and Endocrine Society of  India