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In Reply.—We concur with Dr Smith. This was our first encounter with this child, who had never received regular medical care. Her mother had died, and she was living with her sister. There were no available medical records. Unfortunately, this is not uncommon. Many children with Down's syndrome in rural West Virginia receive only episodic, acute care. However, we obtain yearly thyroid function tests as a part of our routine examination of patients with Down's syndrome.