Infantile
hemangiomas (IHs) are common, although systemic
therapy has been generally limited to circumstances of potential compromise of vital functions (airway, vision, feeding, or cardiac), risk of disfigurement, or
bleeding. IHs have previously been shown to express high levels of
type III deiodinase, which catabolizes active
thyroid hormone, resulting in a state of severe
hypothyroidism, termed "consumptive
hypothyroidism." We describe an infant with diffuse hepatic
hemangiomas who developed consumptive
hypothyroidism who was initially treated successfully with systemic
glucocorticoids and β-blockers. Several efforts to wean her medications were unsuccessful. She subsequently developed severe growth restriction and treatment alternatives were sought. Although previously limited to treatment of life-threatening
hemangiomas, a trial of
vincristine was initiated. She was ultimately weaned from all systemic
therapies, with recovery of a normal growth trajectory. This case highlights broader indications for
vincristine as a safe and effective systemic
therapy for treatment of IHs. It also stresses the importance of close anthropometric monitoring of infants and toddlers receiving
glucocorticoid therapy and intervention when growth compromise becomes evident.