J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://jmc.elmerpub.com

Case Report

Volume 17, Number 11, November 2026, pages 628-636

Reversible Thyroid Nodule in Van Wyk–Grumbach Syndrome: An Unusual Case Report

↓ Figure 1. Anthropometric measurements before and after levothyroxine therapy. Weight-for-age and height-for-age percentile charts for Saudi girls illustrating the patient’s growth trajectory at presentation. The plotted points indicate improvements in growth parameters before and after the initiation of levothyroxine therapy (arrow).

↓ Figure 2. Thyroid and pelvic ultrasound imaging. (a, b) Thyroid ultrasound demonstrates a hypoechoic nodule in the right lobe. (c, d) Pelvic ultrasound showing bilateral multi-cystic ovaries (arrows) consistent with Van Wyk-Grumbach syndrome and a prepubertal uterus in size and configuration.

↓ Figure 3. Pituitary magnetic resonance imaging. (a, b) Baseline sagittal and coronal T1-weighted post-contrast images showing pituitary hyperplasia with suprasellar extension (arrows). (c, d) Follow-up imaging at 9 months demonstrated a marked reduction in pituitary size after levothyroxine therapy.

↓ Figure 4. Temporal changes in thyroid function tests during levothyroxine therapy. Serial measurements of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) during follow-up after initiation of levothyroxine therapy. The graph demonstrates progressive normalization of thyroid function, with a marked decline in TSH levels accompanied by a corresponding increase in FT4 concentrations over the follow-up period.

↓ **Table 1.** Baseline and Longitudinal Follow-Up Laboratory Parameters in Patients Diagnosed With Van Wyk–Grumbach Syndrome
Parameter	At diagnosis	3 months	6 months	9 months	Reference range	Interpretation
Anti-TG: anti-thyroglobulin antibodies; Anti-TPO: anti-thyroid peroxidase antibodies; DHEA-S: dehydroepiandrosterone sulfate; FSH; follicle-stimulating hormone; FT4: free thyroxine; FT3: free triiodothyronine; IGF-1: insulin-like growth factor-1; IGFBP-3: insulin-like growth factor-binding protein-3; LH: luteinizing hormone; MCH: mean corpuscular hemoglobin; MCHC: mean corpuscular hemoglobin concentration; MCV: mean corpuscular volume; RDW: red cell distribution width; TSH: thyroid-stimulating hormone.
Hematology
Hemoglobin (g/dL)	10.6	11.8	12.2	12.4	11.5–14.5	Macrocytic hyperchromic anemia at baseline, normalized with treatment.
MCV (fL)	95.4	84.2	82.1	81.5	75–87	Elevated at baseline, normalized
MCH (pg)	30.9	27.8	26.9	26.2	24–30
MCHC (g/dL)	32.3	33.1	32.8	32.6	31–35	Normal throughout
RDW (%)	13.7	13.2	12.9	12.8	11.6–14
Thyroid function
TSH (mIU/L)	> 75	4.2	2.1	1.8	0.25–5	Markedly elevated at baseline, normalized by 3 months.
FT4 (pmol/L)	9.1	18.3	17.1	16.8	13.9–22.1	Low at baseline, normalized by 3 months
FT3 (pmol/L)	3.4	5.2	5.0	4.9	3.8–8.6
Thyroid autoantibodies
Anti-TG (U/mL)	161.7	-	-	115.2	< 15	Positive, gradually declining
Anti-TPO (U/mL)	190.1	-	-	138.7	< 15
Reproductive hormones
LH (IU/L)	< 0.21	< 0.21	0.32	0.45	1.3–1.4	Prepubertal at baseline, gradually increasing
FSH (U/L)	7.01	3.21	2.45	2.12	1.9–2.3	Elevated at baseline, normalized
Prolactin (ng/mL)	173	28	18	14	4.0–25	Markedly elevated at baseline, normalized by 3 months
Estradiol (pg/mL)	82	35	22	18	Up to 27	Elevated at baseline, normalized
Progesterone (ng/mL)	0.04	0.05	0.06	0.05	< 0.35	Normal throughout
DHEA-S (µg/dL)	10.3	12.1	14.5	16.8	54.4–254.0	Low, gradually increasing with age
Growth Factors
IGF-1 (ng/mL)	98	112	128	145	88–246	Normal, increasing with treatment
IGFBP-3 (µg/mL)	2.8	3.2	3.5	3.8	2.1–5.2

↓ Table 1. Baseline and Longitudinal Follow-Up Laboratory Parameters in Patients Diagnosed With Van Wyk–Grumbach Syndrome

Parameter

At diagnosis

3 months

6 months

9 months

Reference range

Interpretation

Anti-TG: anti-thyroglobulin antibodies; Anti-TPO: anti-thyroid peroxidase antibodies; DHEA-S: dehydroepiandrosterone sulfate; FSH; follicle-stimulating hormone; FT4: free thyroxine; FT3: free triiodothyronine; IGF-1: insulin-like growth factor-1; IGFBP-3: insulin-like growth factor-binding protein-3; LH: luteinizing hormone; MCH: mean corpuscular hemoglobin; MCHC: mean corpuscular hemoglobin concentration; MCV: mean corpuscular volume; RDW: red cell distribution width; TSH: thyroid-stimulating hormone.

Hematology

Hemoglobin (g/dL)

10.6

11.8

12.2

12.4

11.5–14.5

Macrocytic hyperchromic anemia at baseline, normalized with treatment.

MCV (fL)

95.4

84.2

82.1

81.5

75–87

Elevated at baseline, normalized

MCH (pg)

30.9

27.8

26.9

26.2

24–30

MCHC (g/dL)

32.3

33.1

32.8

32.6

31–35

Normal throughout

RDW (%)

13.7

13.2

12.9

12.8

11.6–14

Thyroid function

TSH (mIU/L)

> 75

4.2

2.1

1.8

0.25–5

Markedly elevated at baseline, normalized by 3 months.

FT4 (pmol/L)

9.1

18.3

17.1

16.8

13.9–22.1

Low at baseline, normalized by 3 months

FT3 (pmol/L)

3.4

5.2

5.0

4.9

3.8–8.6

Thyroid autoantibodies

Anti-TG (U/mL)

161.7

115.2

< 15

Positive, gradually declining

Anti-TPO (U/mL)

190.1

138.7

< 15

Reproductive hormones

LH (IU/L)

< 0.21

0.32

0.45

1.3–1.4

Prepubertal at baseline, gradually increasing

FSH (U/L)

7.01

3.21

2.45

2.12

1.9–2.3

Elevated at baseline, normalized

Prolactin (ng/mL)

173

4.0–25

Markedly elevated at baseline, normalized by 3 months

Estradiol (pg/mL)

Up to 27

Elevated at baseline, normalized

Progesterone (ng/mL)

0.04

0.05

0.06

0.05

< 0.35

Normal throughout

DHEA-S (µg/dL)

10.3

12.1

14.5

16.8

54.4–254.0

Low, gradually increasing with age

Growth Factors

IGF-1 (ng/mL)

112

128

145

88–246

Normal, increasing with treatment

IGFBP-3 (µg/mL)

2.8

3.2

3.5

3.8

2.1–5.2

↓ **Table 2.** Reported Thyroid Morphological and Structural Abnormalities Documented in Published Pediatric Cases of Van Wyk–Grumbach Syndrome
Year	Author	Study type (N)	Thyroid imaging findings	Thyroid nodule	Ref.
“-” indicates that no thyroid nodule was reported. FT4: free thyroxine; NR: not reported; TSH: thyroid-stimulating hormone; US: ultrasound; VWGS: Van Wyk–Grumbach syndrome.
2007	Sanjeevaiah et al	Case report	NR	-	[15]
2012	Baranowski et al	Case report	NR	-	[9]
2012	Patni et al	Case report + review	NR	-	[16]
2015	Bhagwat et al	Case report	NR	-	[17]
2016	Kocova et al	Case series (8)	NR	-	[18]
2018	Leonardi et al	Case report	Enlarged gland with heterogeneous echotexture	-	[19]
2018	Reddy et al	Case report	NR	-	[20]
2020	Lee et al	Case report	Decreased thyroid volume on ultrasound	-	[21]
2020	Gupta et al	Case report	NR	-	[22]
2020	Riaz et al	Case series (10)	Radiologic profile described; thyroid details not reported	-	[23]
2022	Kandasamy et al	Case report	US performed; morphology not detailed	-	[24]
2023	Kusuma Boddu et al	Cohort (30)	Goiter variably reported; structural imaging not detailed	-	[13]
2023	Sherwani et al	Case report	Imaging focused on VWGS; thyroid morphology not detailed	-	[25]
2023	Waddankeri et al	Case series (3)	NR	-	[26]
2023	Marzouk et al	Case report	US and scintigraphy suggest thyroiditis	-	[27]
2024	Nicolescu et al	Case series (2)	Moderate goiter on US in one patient	-	[14]
2024	Rathod et al	Case report	NR	-	[28]
2024	Baioumi et al	Case report	NR	-	[29]
2024	Mukhopadhyay et al	Case series (3)	NR	-	[30]
2025	Ganta et al	Case report	NR	-	[31]
2025	Sivasubramanian et al	Case report	NR	-	[32]
2025	Gil et al	Case report	NR	-	[33]
2026	Cao et al	Case report	NR	-	[12]

↓ Table 2. Reported Thyroid Morphological and Structural Abnormalities Documented in Published Pediatric Cases of Van Wyk–Grumbach Syndrome

Year

Author

Study type (N)

Thyroid imaging findings

Thyroid nodule

Ref.

“-” indicates that no thyroid nodule was reported. FT4: free thyroxine; NR: not reported; TSH: thyroid-stimulating hormone; US: ultrasound; VWGS: Van Wyk–Grumbach syndrome.

2007

Sanjeevaiah et al

Case report

[15]

2012

Baranowski et al

Case report

[9]

2012

Patni et al

Case report + review

[16]

2015

Bhagwat et al

Case report

[17]

2016

Kocova et al

Case series (8)

[18]

2018

Leonardi et al

Case report

Enlarged gland with heterogeneous echotexture

[19]

2018

Reddy et al

Case report

[20]

2020

Lee et al

Case report

Decreased thyroid volume on ultrasound

[21]

2020

Gupta et al

Case report

[22]

2020

Riaz et al

Case series (10)

Radiologic profile described; thyroid details not reported

[23]

2022

Kandasamy et al

Case report

US performed; morphology not detailed

[24]

2023

Kusuma Boddu et al

Cohort (30)

Goiter variably reported; structural imaging not detailed

[13]

2023

Sherwani et al

Case report

Imaging focused on VWGS; thyroid morphology not detailed

[25]

2023

Waddankeri et al

Case series (3)

[26]

2023

Marzouk et al

Case report

US and scintigraphy suggest thyroiditis

[27]

2024

Nicolescu et al

Case series (2)

Moderate goiter on US in one patient

[14]

2024

Rathod et al

Case report

[28]

2024

Baioumi et al

Case report

[29]

2024

Mukhopadhyay et al

Case series (3)

[30]

2025

Ganta et al

Case report

[31]

2025

Sivasubramanian et al

Case report

[32]

2025

Gil et al

Case report

[33]

2026

Cao et al

Case report

[12]