46 ENDOCRINE THERAPEUTICS 



perspiration, in fact, a mild imitation of the signs 

 of Graves' disease. If full doses be continued 

 loss of weight may be considerable. In practice 

 we have to deal mostly with hypothyroid con- 

 ditions. (The hyperthyroid disease known as 

 Graves' disease will be dealt with separately.) 

 There may be congenital complete absence of 

 thyroid ; this is rare, and the child living on its 

 mother's thyroid for the first year soon after fades 

 away. What we have to deal with generally is 

 the state of partial hypothyroidism known as 

 cretinism. There may be a complete, unmistak- 

 able picture of this condition, but more commonly 

 variations and modifications. 



In children, if the thyroid is removed or becomes 

 atrophied, the following are the chief symptoms 

 we observe : an arrest of growth, especially of the 

 skeleton, with delayed development of the gonads ; 

 the skin is swollen, the hair thin and much in- 

 clined to fall, the face pale and puffy, particularly 

 under the lower eyelids, the abdomen swollen, 

 the bridge of the nose depressed, the hands and 

 feet podgy but not properly pitting on pressure ; 

 the higher functions of the nervous system remain 

 undeveloped, and this is thought to be due to 

 arrested development of the cortex cerebri. 

 Such is cretinism ; we may find only some of the 



