Cretinism

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Overview

The word cretin is termed as the iodine deficiency disorder which is associated with insufficient intake of the thyroid hormone activity that occurs during the fetal, infant, or childhood phases. The word cretin is derived from the French word chrétien, literally meaning “Christian” or “Christ-like” as the diseased were mentally retarded and incapable of doing sin.

This medical condition affects humans differently according to the age it is being affected. In children, this condition is developed due to hypothyroidism which induces mental and physical retardation. During maternal hyperestrogenism, the TBG (Thyroxine binding globulin) may be elevated and therefore the total T4 (thyroxine or tetraiodothyronine) and T3 (triiodothyronine)may be normal. The lack of feedback will also give an elevated TSH level. Prompt diagnosis and treatment are important in cretinism since any delay in initial replacement may lead to irreversible damage.

Maternal hypothyroidism may also cause neonatal cretinism. Hypothyroidism may result from treatment of hyperthyroidism using antithyroid drugs or radioactive iodine. Replacement of the hormone will produce an immediate effect. This condition is developed due to the breakdown of thyroid development or a deficit in hormone synthesis which is known as sporadic cretinism or due to the extreme iodine deficiency known as endemic cretinism.

This is mainly differentiated between the infant period of childhood, and it is preferred to prevent this condition by screening the neonates. Everyday treatment with thyroxine (8-12 ug/kg) should be started as early as possible as mental retardation that has ensued already is only partially reversible. In this case, the response obtained is partial in which the physical development and growth are revived, and additional mental retardation is checked.

Symptoms

Signs of cretinism or congenital hypothyroidism in a newborn include:


lack of weight gain

stunted growth

fatigue, lethargy

poor feeding

thickened facial features

abnormal bone growth

mental retardation

very little crying

excessive sleep

constipation

yellowing of the skin and whites of the eyes (jaundice)

floppiness, low muscle tone

hoarse voice

unusually large tongue

swelling near the navel (umbilical hernia)

cool, dry skin

pale skin

swelling of the skin (myxedema)

swelling in the neck from an enlarged thyroid gland (goiter)

Causes

Congenital hypothyroidism in newborns can be caused by:

a missing, poorly formed, or abnormally small thyroid gland

a genetic defect that affects thyroid hormone production

too little iodine in the mother’s diet during pregnancy

radioactive iodine or antithyroid treatment for thyroid cancer during pregnancy

use of medicines that disrupt thyroid hormone production — such as antithyroid drugs, sulfonamides, or lithium — during pregnancy

Iodine deficiency is no longer considered a health risk in the United States due to the introduction of iodized salt. However, it’s still the most common preventable causeTrusted Source of impaired neurological function in the world.

Because our bodies don’t make iodine, we need to get it from food. Iodine gets into food through soil. In some parts of the world, the soil is lacking in iodine.


Risk factors

Although anyone can develop hypothyroidism, you're at an increased risk if you:


Are a woman

Are older than 60

Have a family history of thyroid disease

Have an autoimmune disease, such as type 1 diabetes or celiac disease

Have been treated with radioactive iodine or anti-thyroid medications

Received radiation to your neck or upper chest

Have had thyroid surgery (partial thyroidectomy)

Have been pregnant or delivered a baby within the past six months

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Complications

Children who are born with a severely underactive thyroid gland can develop intellectual disability if the condition isn’t treated quickly. A child’s IQ can drop several points for every few months that treatment is delayed. Growth and bone strength can also be affected.


Other complications of congenital hypothyroidism include:


an abnormal walk

muscle spasticity

an inability to speak (mutism)

autistic behavior

vision and hearing problems

problems with memory and attention

Even with treatment, some children with congenital hypothyroidism may be slower to learn than other kids their age.

Prevention

About one billion people worldwide risk the consequences of iodine deficiency, all of which can be prevented by adequate maternal and infant iodine nutrition. Iodized salt is usually the preferred prophylactic vehicle, but iodized vegetable oil, iodized water, and iodine tablets are also occasionally used.