A 3 ½-YEAR-OLD GIRL was initially referred for evaluation of hypothyroidism and small soft-tissue nodules. Review of her growth data showed her height at the fifth percentile and weight at the 50th percentile since her first year of life. The initial physical examination showed a normal-sized thyroid gland, short metacarpals, and soft-tissue nodules measuring 0.3 to 0.5 cm in diameter located over two fingers, the left tibia, and the left Achilles tendon. Thyroid function tests indicated a thyroxine level of 81 nmol/L (6.3 μg/dL) (normal, 93.9-193 nmol/L [7.3-15.0 μg/dL]) and thyrotropin (TSH) of 15.8 mU/L (normal, 0.6-6.3 μU/mL). Serum calcium and phosphate levels were normal, but the parathyroid hormone (PTH) level was elevated, measuring 271 pg/mL (normal, 10-65 pg/mL). Normal calcium and phosphate levels were maintained, and the patient was treated with L-Thyroxine for hypothyroidism. At age 7, she developed pain in the plantar aspect of her left foot.