HYPOTHYKQIDISM 



437 



poor. Physical examination does not suggest typical cretinism, for the boy 

 is over-thin, his face is narrow and pinched. The eyebrows are very scanty, 

 the eyes and nose small, nares flaring, thyroid cannot be palpated, and 

 the skin is dry. His abdomen is fuller than usual in contour ; his gait is 

 awkward, his body movements weak. His temperature is subnormal and 

 pulse is 70. Diagnosis of hypothyroidism could be made in view of the 

 family history and the signs present, with the help of rontgenological 

 plates which exhibited marked underdevelopment of the bones of the skull 



TABLE 1. NITROGEN BALANCE IN HYPOTHYROIDISM, CASE No. 1938 



TABLE 2. NITROGEN BALANCE IN HYPOTHYROIDISM, CASE No. 1939 



and face (see Fig. 18). Metabolic studies were carried out which demon- 

 strated his inability to gain weight or nitrogen on a very full assimi- 

 lable diet (see Table 2). There was great improvement on thyroid 

 treatment. 



Case No. 1938. Female, age 6 years. Growth was normal until 4th 

 year, but only 3 pounds have been gained during the past 2 years. The 

 child, superficially observed, has the appearance of perfect health. The 

 face is normal in appearance ; the nutrition is excellent ; but on thorough 

 examination there were observed thin, underdeveloped nails, tendency to 

 decreased muscle toiras, a scarcely palpable thyroid, dry harsh skin, eczem- 



