The Hypothyroid Infant and Child

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Abstract
Periodic roentgenograms, in conjunction with repeated serum hormonal iodine determinations, represent useful and important guides to clinical evaluation of therapy in the hypothyroid infant or child. This opinion rests largely upon studies, conducted at the University of California Medical Center, on the role of thyroid in growth and development of athyroid infant monkeys (1-8). These investigations revealed that (a) doses of sodium l-thyroxine sufficient to promote continuing central-nervous-system growth and skeletal growth and maturation at normal rates were similar in quantity and (b) that these doses were significantly larger than those required merely to reverse superficial signs of thyroid privation and bring about a more normal metabolism of skin, liver, muscle, and the cardiovascular system. Wilkins (9) had previously stressed the relationship between mental and skeletal development during therapy of the hypothyroid child. Hypothyroid infants and children under treatment in the Endocrine and Metabolic Clinic, Department of Pediatrics, University of California, have been followed in recent years with these points in mind. During this period, those patients who were found to have been inadequately treated were placed on a regimen devised to provide hormone in doses which promote normal skeletal development. It is unfortunate that the majority of cases referred to the Clinic were either undiagnosed or, more often, inadequately treated (by the above standards) during the early critical months of central-nervous-system and skeletal growth and development. A detailed account of 12 representative cases with correlation of data regarding growth, mental development, metabolic responses, hormone doses, and serum hormonal iodine levels during adequate and inadequate therapy with desiccated thyroid and sodium l-thyroxine has been published (10). The present communication is based on roentgenographic observations made during that study. Cases have been selected from the related clinical report to permit a more complete presentation of the roentgen features. Methods Routine serial roentgenograms were obtained as follows: (a) postero-anterior of both hands; (b) anteroposterior of left elbow; (c) anteroposterior of left hip; (d) anteroposterior of left knee; (e) lateral of left ankle. In infants and young children, the examination was repeated at six-month to one-year intervals. Roentgenograms of the hand and wrist have been found to be of greatest value in evaluation of skeletal maturation during therapy. Interpretation of the films has been based on the maturity indicators of the individual bones of the hand and the epiphyses as demonstrated in detail by Greu-lich and Pyle (11).

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