Hashimoto’s Thyroiditis and Obstructive Sleep Apnea in a 10-Year-Old Presenting with Slipping Grades and Fatigue

This case study examines a 10-year-old female, Avery Brook, who presents with a chief complaint of “slipping grades” over the past 4–5 months, accompanied by fatigue, cognitive fog, hypersomnolence, and neck discomfort. The history, review of systems, and physical examination reveal grade 3+ tonsillar hypertrophy, a mild goiter, dry skin, bradycardia, and delayed reflexes. Diagnostic testing confirms primary hypothyroidism (TSH 12.4 mIU/L, low Free T4, positive TPO antibodies) consistent with Hashimoto’s Thyroiditis, and pediatric obstructive sleep apnea (AHI 6 events/hr). ADHD, major depressive disorder, and iron deficiency anemia are considered as differentials but are largely ruled out or deemed secondary. The plan includes levothyroxine therapy, ENT referral for possible tonsillectomy/adenoidectomy, sleep hygiene education, and follow-up lab monitoring. A nursing care plan addresses fatigue, disturbed sleep patterns, and ineffective family coping.