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HYPOTHYROIDISM IN CHILDHOOD. I. BASAL METABOLIC RATE, SERUM CHOLESTEROL AND URINARY CREATINE BEFORE TREATMENT¹

Department of Pediatrics, Johns Hopkins University School of Medicine and the Harriet Lane Home of the Johns Hopkins Hospital Baltimore, Maryland

THYROID DEFICIENCY during childhood often gives rise to physical signs which can be readily recognised. Growth is delayed, the ossification of the epiphyseal cartilages and the eruption of teeth are delayed, the proportions of the upper and lower skeletal segments remain those of a younger child, the nasoorbital configuration fails to mature as in the normal child so that the bridge of the nose remains broad and flat as in the infant. The skin and hair sometimes, but not always, show the changes similar to those of adult myxedema. The lowered metabolism is manifested in mental and physical torpor and a sluggish peripheral circulation, causing pallor of the skin. It is apparent that many of the physical signs upon which the diagnoses of hypothyroidism in childhood depend are due to the retardationor distortion of normal proc esses of growth and development occurring over a considerable period of time. The occurrence of these signs, or their severity, depends upon the age of the patient when thyroid deficiency develops and the duration and degree of deficiency. If hypothyroidism develops in a late period of childhood when the more mature characteristics of the skeleton already have been attained, structural abnormalities will be absent or of mild degree. If the deficiency is of only short duration, the deviation from normal will not be appreciable. If treatment with thyroid has been administered during the crucial stages of development, all structural abnormalities may be prevented. Likewise, it is theoretically possible that a very mild degree of hy pothyroidism.mightexist throughout childhood without causing characteristic abnormalities of body structure. There is no uniform opinion as to the symptoms of mild or borderline forms of hypothy roidism in childhood, and the diagnosis has often been made without substantial proof. Since hypothyroidism may occur without causing uniform and characteristic structural changes, the diagnosis must depend upon a study of functional changes, such as alterations in the basal metabolism, the body chemistry or the circulation.

¹ This work was aided from January to July, 1938, by a grant from The John and Mary Markle Foundation and since September, 1938, has been supported by the Commonwealth Fund.

Received May 16, 1940.

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