For a five-year-old adopted child with short stature and high weight percentiles, what is the most appropriate next step?

For a five-year-old adopted child with short stature and high weight percentiles, what is the most appropriate next step?

• A. Order thyroid function tests
• B. Obtain a bone age radiograph
• C. Prescribe a 1,200 kcal/day calorie-restricted diet
• D. Inform parents this is normal for ethnicity

Answer: (A)

The key idea is recognizing hypothyroidism as a reversible cause of growth delay with weight gain in a child. When a young child presents with short stature and high weight percentiles, thyroid function should be tested first because untreated hypothyroidism can slow linear growth and lead to weight gain; identifying and treating it can normalize growth and help stabilize weight. Screening with thyroid function tests (typically TSH and free T4) is the best next step. If TSH is elevated with a low or low‑normal free T4, that indicates hypothyroidism and warrants thyroid hormone replacement, which often improves growth velocity and weight trajectory. If thyroid tests are normal, you would then pursue other causes of short stature and obesity. Avoid drastic caloric restriction in a child or assuming normalcy based on ethnicity, as these do not address the underlying growth issue. A bone age radiograph can be informative later for growth assessment but does not diagnose hypothyroidism and is not the initial test of choice.

The key idea is recognizing hypothyroidism as a reversible cause of growth delay with weight gain in a child. When a young child presents with short stature and high weight percentiles, thyroid function should be tested first because untreated hypothyroidism can slow linear growth and lead to weight gain; identifying and treating it can normalize growth and help stabilize weight.

Screening with thyroid function tests (typically TSH and free T4) is the best next step. If TSH is elevated with a low or low‑normal free T4, that indicates hypothyroidism and warrants thyroid hormone replacement, which often improves growth velocity and weight trajectory. If thyroid tests are normal, you would then pursue other causes of short stature and obesity.

Avoid drastic caloric restriction in a child or assuming normalcy based on ethnicity, as these do not address the underlying growth issue. A bone age radiograph can be informative later for growth assessment but does not diagnose hypothyroidism and is not the initial test of choice.