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The abdomen is protuberant, often with an umbilical hernia, and the head is small a physical appearance that prompted William Boyd to remark: What was intended to be created in the image of God has turned out to be the pariah of nature, all for the want of a little thyroid DeLong and others attribute neurologic cretinism to a lack of available iodine in the mother and fetus during the second and third trimesters of pregnancy; neither mother nor fetus elaborate thyroxine The rst and part of the second trimester developmental period, which does not require iodine or thyroxine, passes normally and the general morphology of the brain is normal It is during the latter part of the second trimester, when the cochleas and the neuronal population of the cerebral cortex and basal ganglia are forming, that these structures suffer irreparable damage.

Work the following problems to practice the commands and skills you learned in this chapter. 1. Create a new drawing. Draw a circle and a rectangle as illustrated in Fig. 6-8. Use the RECTANG command to create the rectangle. Then enter the ERASE command and try to erase one line of the rectangle. At another location in the drawing, create another rectangle, but this time use the LINE command. Try to erase one line of the second rectangle. What is the difference Do not save the drawing.

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The effects of this midfetal hypothyroidism and iodine de ciency cannot be corrected by giving thyroid hormone at birth and thereafter It can be prevented only by providing iodine therapy to the mother before and during the rst trimester of pregnancy (Cao et al) The myxedematous form of cretinism is more likely to occur from lack of thyroid hormone in the late second and the third trimesters The mental defect ranges from apathy and absence of social interaction to an alert, cooperative state, but a backwardness in higher-order thinking and verbal facility is always evident Retentive memory and apperception are commensurate with overall intellectual competence as judged by the level of mental associations and capacity for abstract thought The status of the thyroid gland varies; among neurologic cretins, about half are goitrous or have palpable glands; in the rest, the glands are atrophied; practically all the myxedematous cretins are athyreotic.

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Although typical examples of neurologic and myxedematous hypothyroidism are readily distinguished, both types may exist in the same endemic area, and the stigmata of both forms may be recognized in the same individual The QRS complex of the ECG is of low voltage; the EEG is slower than normal, with less alpha activity; the CSF contains an excess of protein (50 to 150 mg/dL); and the serum T3 and T4, protein-bound iodine, and radioactive iodine uptake are all subnormal Serum cholesterol is increased (300 to 600 mg/dL) At autopsy the brain of neurologic cretinism, though small, is normally formed, with all central and brainstem structures and cortical sulcation intact A reduction in number of nerve cells was described by Marinesco, especially in the fth cortical layer, but others have not con rmed this nding.

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