When severe thyroid deficiency has existed over a considerable span of time during the early years of growth, it gives rise to the classic clinical pictures described as cretinism or as juvenile hypothyroidism, which are readily recognized. Many cretins, however, when seen in the first year or two of life, are less grotesquely abnormal, and on superficial inspection might be mistaken for fairly normal infants considerably younger than their actual age. In studying dwarfs of an older age, one finds almost innumerable variations and gradations from the broad, stocky build of the typical person with hypothyroidism to the slender, wiry, small-featured dwarf who presents no suggestion of thyroid deficiency.
Great differences of opinion have arisen as to what constitutes the signs of hypothyroidism in cases not presenting the frank, typical picture. In recent years there have been a lack of critical analysis and an excess of enthusiasm, so that the
WILKINS L, FLEISCHMANN W. THE DIAGNOSIS OF HYPOTHYROIDISM IN CHILDHOOD. JAMA. 1941;116(22):2459-2465. doi:10.1001/jama.1941.02820220001001