Background: Hashimoto thyroiditis is the most common cause of acquired hypothyroidism in children and adolescents. Delayed diagnosis may lead to growth retardation, pubertal abnormalities, and other systemic manifestations. Early identification and appropriate management are essential to prevent long-term complications. Case Report: An 11-year-old female with newly diagnosed hypothyroidism presented with significant hair loss following initiation of levothyroxine therapy. Clinical evaluation revealed pathological short stature, history of early menarche with subsequent menstrual irregularity, and absence of progressive secondary sexual characteristics. Laboratory investigations showed low FT3 levels with elevated anti-thyroid peroxidase (135 IU/mL) and thyroglobulin antibodies (16.6 IU/mL), confirming Hashimoto thyroiditis. Mild anemia and acanthosis nigricans were also noted. The patient was managed with levothyroxine dose optimization, nutritional supplementation, and endocrine follow-up. Clinical pharmacist interventions included identification of a potential levothyroxine–iron interaction, evaluation of medication-related adverse effects, and recommendations for growth and pubertal monitoring. Conclusion: This case highlights the atypical presentation of Hashimoto thyroiditis with short stature, pubertal disturbance, and telogen effluvium in a pediatric patient. Early diagnosis, individualized thyroid hormone therapy, and multidisciplinary care are crucial for improving growth, pubertal development, and overall clinical outcomes.
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