Metrorrhagia and precocious puberty revealing primary hypothyroidism in a child with Down's syndrome

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Figure 1.

The patient's growth chart. The arrow indicates the beginning of thyroxine replacement therapy.

Figure 2.

Ultrasound scan of (A) the left ovary (measuring 70x39 mm), and (B) the right ovary (measuring 45x29 mm). The ovaries are notably enlarged and muticystic in aspect.