Adult studies have reported associations of low 25-hydroxyvitamin D (25OHD) with dyslipidemia and cardiovascular disease; however, there are scarce pediatric data regarding relationships between vitamin D status and specific lipid markers affecting cardiovascular risk. In this cross-sectional study of children evaluated at university-based pediatric endocrinology clinics, 178 patients meeting criteria for overweight or obesity had 25OHD levels assessed over a 2-year period; 60 of 178 had non-HDL (high-density lipoprotein) cholesterol and fasting lipid parameters performed. Patients with 25OHD <20 ng/mL had significantly higher non-HDL cholesterol (134.76 ± 47.32 vs 108.85 ± 31.14, P < .03), triglyceride (TG)/HDL ratio (3.09 ± 2.26 vs 1.82 ± 1.18, P = .03), total cholesterol (TC)/HDL ratio (4.23 ± 1.23 vs 3.40 ± 1.05, P < .01), TC (184.15 ± 40.19 vs 158.89 ± 30.10, P < .01), and TG (134.76 ± 47.32 vs 78.93 ± 37.46, P < .03) compared with 25OHD ≥20 ng/mL. Vitamin D deficiency was significantly associated with increase in atherogenic lipids and markers of early cardiovascular disease. These findings suggest that vitamin D deficiency may have negative effects on lipid parameters with increase in cardiovascular risk.

We report the case of a 10 year old male with severe obesity who presented with a 2 year history of significant growth failure and excessive weight gain that was subsequently diagnosed with serum negative Hashimoto's thyroiditis and acquired hypothyroidism. Initial investigations revealed a markedly elevated thyroid stimulating hormone (TSH) concentration >100 uIU/mL and an undetectable free thyroxine with total thyroxine 0.56 ug/dL. Thyroid antibodies were negative, however ultrasound findings were consistent with Hashimoto's thyroiditis. After treatment with levothyroxine supplementation, he had significant weight loss and marked improvement in his growth velocity. This case emphasizes the need to recognize excessive weight gain and growth failure as an initial presentation of Hashimoto's thyroiditis and highlights management and approach to treatment. Diagnosis and treatment is vital as prolonged undiagnosed hypothyroidism can result in incomplete catch up growth and compromised final adult height.