It should be kept in mind that there are many gradations and
alterations in both hyperthyroidism and hypothyroidism, and that a
“goiter” may present either picture, partly or wholly, or on the other
hand may be normally functioning.
MacCallum says: “Unlike the myxedema cases which occur anywhere and
everywhere, regardless of environment or hereditary taint, these
people, known as cretins, are found in regions where the condition
seems to be endemic or inherent in the environment, and we can usually
trace in their parents or ancestors some similar thyroid defect.”
This disease is found in various countries, particularly in certain
parts of Switzerland, Austria, and Italy. McCarrison presents an
interesting study of 203 cases of Endemic Cretinism found in Himalayan
India. He thinks it is due to infection. There are a few cases in North
America, probably mostly due to immigration. It is frequently confused
with myxedema.
Cretins are of short stature, flat-chested and pot-bellied. The face
is broad, low forehead, broad nose, prominent cheeks, thick lips, and
large nose. The development of the bones is retarded; the skin is
thickened and edematous; the hair is thin, and the nails brittle; the
sexual organs as a rule do not develop; and in most cases a goiter,
sometimes of huge size, is present. Most of them are stupid and
apathetic; others are distinct idiots. Deafness is common.
There are sporadic and endemic cases, but the same underlying cause is
probably present. It is claimed that most cases of the former should be
classed as congenital myxedema.
Early diagnosis is essential. Removal of the patient from the goiter
region, and thyroid substance is the treatment given, though results
are not so marked as in myxedema.