Abstract
Twelve apparently euthyroid patients from Goiaz, Brazil, with the neurological form of endemic cretinism manifested by mental retardation, short stature, upper-motor-neurone disease, deaf-mutism, and multinodular goitre were studied. Although standard thyroid-function studies were normal, subtle evidence of thyroid dysfunction was uncovered. Three of the twelve had total and free thyroxine levels slightly below normal; six had raised basal thyrotrophin levels; five had an increased thyrotrophin response to thyrotrophin-releasing hormone (T.R.H.); and six had a diminished thyroidal response to T.R.H. In contrast, pituitary response to gonadotrophin-releasing hormone was normal. The demonstration that cretins previously thought to be euthyroid do indeed have evidence of thyroidal failure supports the view that these patients were hypothyroid during a critical stage of embryogenesis, resulting in irreversible neurological damage.
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