An 11-year-old girl presented to the pediatric gastroenterology outpatient department of our institution with gradually increasing painless abdominal distention. The distention started 2 years earlier and was not associated with any other constitutional symptoms, vomiting, diarrhea, jaundice, hematemesis, or melaena. She reported early satiety and heaviness in the lower abdomen. The abdominal swelling was predominantly in the infraumbilical region and was soft at palpation. She was the first child of nonconsanguineous parents and had an uneventful perinatal course after a normal vaginal delivery. Her developmental milestones were normal. She had an average scholastic performance at school. There was no history of visual problems, seizures, or inappropriate behaviors. She had an early menarche 2 years previously. Her menstrual cycles were regular, and there was no abnormal vaginal discharge. Her breast development was normal (T anner stage III), while pubic and axillary hair were absent (T anner stage I). She was short for her age (104 cm; normal range, 120–154 cm). There was no history of short stature among her siblings or parents. Laboratory investigations were performed to measure thyroid-stimulating hormone (1354.34 μIU/mL; normal range, 0.35–5.5 μIU/mL), triiodothyronine (<2.5 ng/dL [0.0385 pmol/L]; normal range, 100–200 ng/dL [1.54–3.08 pmol/L]), thyroxine (1.35 μg/dL [17.37 nmol/L]; normal range, 5–12 μg/dL [64.35–154.44 nmol/L]), β-human chorionic gonadotropin (<1.2 mIU/mL; normal, <5 mIU/mL), luteinizing hormone (0.08 mIU/mL; normal range, 0.1–6.0 mIU/mL), and follicle-stimulating hormone (6.93 mIU/mL; normal range, 0.3–2.0 mIU/ mL) levels. Complete blood count was normal. An abdominal mass was suspected, and abdominopelvic CT was performed and followed by US; these examinations revealed multiple large cysts in both ovaries (Figs 1, 2A, 2B). The uterus was pubertal in shape, and endometrial thickness was 9 mm, representing normal follicular phase measurement. Serum CA-125 and inhibin levels were normal. T o evaluate short stature, radiographs of the hand (Fig 3A) and pelvis (Fig 3B) were obtained as part of a limited skeletal survey, keeping in mind the possible skeletal changes associated with hypothyroidism. In view of the hypothyroidism, US of neck was also performed (Fig 4). T reatment was started based on the clinical and radiologic parameters, and the child’s condition improved with medical treatment.Pelvic US (Fig 1) revealed bilateral enlarged ovaries with multiple clear anechoic cysts. The cysts did not show any echogenic debris, solid component, or calcification.聽Contrast-enhanced CT (Fig 2A, 2B) of the pelvis enabled us to confirm the US findings. The uterus had a normal pubertal appearance. A radiograph of the hand (Fig 3A) showed delayed bone age (2.5 years with the T anner-Whitehouse 2 method) and mild metaphyseal irregularity involving the lower ulna. A radiograph of the pelvis (Fig 3B) showed a delayed appearance of epiphyses around the hip joints. Mild metaphyseal irregularity was noted at the end of long bones as well.聽Although the pelvic US findings were suggestive of precocious puberty, the skeletal changes were consistent with hypothyroidism.聽US of the neck showed absence of a normal thyroid gland (Fig 4), and this was confirmed later with radioiodine scintigraphy. The child was started on 100 碌g of levothyroxine daily, and her abdominal distention and vaginal bleeding abated. What is your diagnosis?