Some unusual manifestations of thyroid disease.

In medical teaching, emphasis is rightly given to the diagnosis of cretinism during the first year or two of life. This is the all-important period, for correct diagnosis and treatment at this stage will largely determine whether the infant grows up to be a normal human being or a hopeless idiot. Nevertheless, not all cretins are detected at an early age, particularly if the defect is incomplete; and of those that are, not all receive continuous replacement therapy throughout the growing period. All too often medication is haphazard or forgotten altogether for long periods. One may therefore be confronted with an adolescent, or even an adult, with signs of incomplete cretinism, presenting with a clinical picture which is rather different from that seen in the infant on the one hand, and in myxoedema developing in adult life on the other. It seems worth noting the salient features of undetected or incompletely treated cretinism, before going on to discuss some of the rarer causes of this condition.