Immunology
The different clinical types of endemic cretinism are, in fact, manifestations of the same basic disorder (foetal bypothyroidism) phenotypically modified by the length and severity of postnatal hypothyroidistan.
Abstract
Eight hundred million of the world's inhabitants live in areas lacking iodine and are at risk of developing one o r more of the complications of iodine deficiency. More than half of those at risk live in the AsiaPacific region with the majority being rural inhabitants of the Peoples Republic of China. Disorders attributable to iodine deficiency include endemic goitre, spontaneous abortion, increased infant mortality and endemic cretinism. The clinical spectrum of endemic cretinism ranges from typical neurological cretinism (gross mental deficiency accompanied by severe neurological dysfunction) t o typical myxoedematous cretinism ( gross mental deficiency associated with persistent congenital hypothyroidism) with considerable overlap between the two syndromes and a high prevalence of subclinical cretinism. The factors that determine the geographical and clinical diversity of this condition have not, until now, been explained. Over the pastfive years, comprehensive clinical, radiological, psychological and biochemical studies have been performed in f o u r iodine deficient Provinces Ln China. These data have revealed that the different clinical types of endemic cretinism are, in fact, manifestations of the same basic disorder (foetal bypothyroidism) phenotypically modified by the length and severity of postnatal hypothyroidism. The latter may be an autoimmune phenomenon as it is characterised by atrophic thyroiditis and the presence of circulating thyroid growth inhibitory immunoglobulins.