PMC9168206_01
PMC9168206_02
Photographs showing edema of both hands and feet.
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fig1
There was visual evidence of facial puffiness and edema in both hands and feet (Figure 1), without calf muscle hypertrophy.
PMC9168206_03
PMC9168206_04
Thyroid ultrasound showing the relatively small size of the lobes and isthmus, diffuse coarse, heterogenous parenchymal echotexture with multiple fibrous echogenic lines, and no focal nodule.
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fig2
An ultrasound of the thyroid showed that both lobes and isthmus were relatively small in size, with diffuse, coarse, heterogenous parenchymal echotexture with multiple fibrous echogenic lines and no focal nodule (Figure 2).
Sagittal and coronal contrast-enhanced T1-weighted magnetic resonance images taken at presentation. The images showed a homogenously enhancing solid mass arising from the pituitary gland with a superior concave border abutting the optic chiasm. There was no cystic/necrotic, haemorrhagic, or calcific component.
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fig3
T2-weighted images with widening of the sella turcica and superior displacement of the pituitary stalk (Figure 3).
Left wrist X-ray showing a bone age of 10 years in contrast to chronological age of 13.6 years. Bone age was determined using Greulich and Pyle's radiographic atlas of skeletal development of the hand and wrist.
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fig4
Despite the child's chronological age being 13 years and 6 months, her bone age was estimated to be 10 years (Figure 4), as per Greulich and Pyle's radiographic atlas of skeletal development of the hand and wrist.
PMC9168206_05
PMC9168206_06
Sagittal and coronal contrast-enhanced T1-weighted magnetic resonance images taken at follow-up after 6 months of thyroid hormone replacement therapy. The images showed a moderate interval reduction in the size of the pituitary mass.
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fig5
The comparison sagittal and coronal T1-weighted images demonstrated a moderate interval reduction in the size of the pituitary mass (now measuring 1.2 x 0.7 x 1.1 cm) (Figure 5).
Sagittal and coronal contrast-enhanced T1-weighted magnetic resonance images taken after two years of follow-up. The images showed significant improvement of the pituitary mass as demonstrated by the marked reduction in size, returning to a normal appearance.
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fig6
Moreover, at 18 months, follow-up sagittal and coronal contrast-enhanced T1 weighted images showed significant improvement of the pituitary mass with a marked reduction in size and returning to normal appearance (Figure 6).