Even now some writings describe hypothyroidism only in its fully developed forms, i. e., generalized myxedema, great skin dryness, retarded mentality, dwarfism, characteristic facies, marked epiphyseal retardation, constipation, somnolence and a low basal rate.
Marked mental retardation does not inevitably develop. In even the patient with congenital thyroid deficiency this retardation will not always develop if he is treated before the age of 6 to 12 months. Acquired hypothyroidism causes slow mental development; however, about 25 per cent of such patients can again attain normal mentality when treated properly. Dwarfism and epiphyseal retardation require at least one or more years to become definitely manifest. Hypothyroid infants do not usually have a high blood cholesterol level.
These and other marked deficiencies may take years to develop in a given patient. Usually, hypothyroidism starts mildly, progresses slowly and insidiously and persists permanently if untreated. Occasionally, the progression of deficiency is steplike. There
Reilly WA. HYPOTHYROIDISM IN CHILDHOOD: ITS GENESIS. JAMA. 1951;146(3):234–236. doi:10.1001/jama.1951.03670030012005
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