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lways necessary to identify the other associated anomalies in addition to the primary diagnosis since these features may direct to a syndromic diagnosis. Acquired hypothyroidism is a relatively common endocrine disorder among children and early recognition is important to prevent serious complications like Van Wyk-Grumbach syndrome. Sexual precocity with delayed bone age and stunting should direct our minds toward this unique diagnosis. It is always necessary to identify the other associated anomalies in addition to the pr