Abstract
This 5-year-old girl presented at the outpatient department of Priti Medical Research & Charitable Trust, Allahabad, India with an inability to speak, lethargy, and a protuberant abdomen. The patient's family were from a very underdeveloped and impoverished area of India, and had not sought medical intervention despite these symptoms being noted from a few months after birth. She was diagnosed with congenital hypothyroidism, and her condition improved when she was given levothyroxine. Indian newborns are not routinely screened for congenital hypothyroidism, with testing only available in big cities for a fee. Consequently, many children are not diagnosed in the crucial first few weeks of life and will become mentally impaired. To view all six images selected for publication see http://www.thelancet.com/landia/endocrinology-in-focus
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