282 chapter 32
HYPOTHYROIDISM (Cretinism)
Hypothyroidism is a delay in both mental and physical growth that comes when a
child’s body does not produce enough ‘thyroid’. Thyroid is a substance, or ‘hormone’,
that controls a child’s growth and body functions. Without it, everything goes slower.
Thyroid is produced by a gland in the front of the
neck. To produce thyroid, the gland needs iodine. Most
people get enough iodine from water and food. But in
some areas, especially in the mountains, the soil, water,
and food have very little iodine. In an attempt to obtain
more iodine, the thyroid gland sometimes grows very
large, forming a swelling called a goiter.
goiter
In areas where there is little iodine and a lot of people
have goiters, hypothyroidism is common. In these areas, many children have difficulty
hearing or are somewhat slow mentally. Although they do not show all the typical
signs of hypothyroidism, the cause is probably the same. Occasionally, in areas where
goiter is not common, hypothyroidism occurs for other reasons than lack of iodine.
SIGNS Below we show some of the typical signs of hypothyroidism and compare
them with Down syndrome, which hypothyroidism resembles in some ways. It is often
difficult to tell if a newborn baby has hypothyroidism. She is often born large and then
fails to grow normally. The baby may have feeding difficulties, or breathing difficulties or
make noises because of the large tongue. She moves and cries little. By 3 to 6 months
the mother often becomes worried because the baby looks dull, takes so little interest in
things, sleeps so much, and is slow in all areas of development.
Signs of HYPOTHYROIDISM
• temperature
below normal
• thick, dry,
cool skin
• hair low on forehead
• puffy eyelids
• flat base of nose between
eyes
• puffy face, hands, and feet
• fatty swelling here
• grows very slowly;
increasingly short for age
• severe constipation (may
go days without shitting)
• often deafness
• As child grows, knees may
get large and painful.
Signs seen in both
HYPOTHYROIDISM
and DOWN
• slow mental and
physical development
• widely separate eyes
• round face, dull look
• tongue sticks out
of open mouth
• short neck and
limbs; wide,
short hands
• big belly and
sway back
• often hernia
of the navel
Signs of DOWN
SYNDROME (that are
most useful in telling it
from hypothyroidism)
• hair starts high on
forehead
• slant eyes with lid fold
over inner corners
For other
signs, see
p. 279.
WHAT TO DO Early and continued treatment with thyroid medicine helps improve
growth, physical appearance, and sometimes can reduce or prevent mental slowness.
For best results, treatment should begin during the first month of life. As soon as you
suspect that a baby might have hypothyroidism, get skilled medical advice.
To help the child develop mentally and physically, and learn basic skills, read
Chapters 34 to 41 and use the ideas that can help meet the child’s needs. With early
treatment and guided learning, many children with hypothyroidism can learn to care
for themselves and do simple but important work in the community. For ideas on
managing constipation, see p. 212.
PREVENTION In areas where goiter is common, hypothyroidism (and deafness) can
be greatly reduced by encouraging everyone to use iodized salt.
Disabled village Children