Cretinism, endemic definition

D. Koutras, S. Muzzo, H. Niepomniszcze, C.S. Pandav and G. Riccabona, Definitions of endemic goiter and cretinism, classification of goiter size and severity of endemias, and survey techniques, ija "Towards the eradication of endemic goiter, cretinism and iodine deficiency",... 

Although the materials studied in the present paper and the above mentioned differences were relatively small, the morphometric changes in the brains of certain iodine deficient fetuses are definite. The results suggest that prenatal iodine deficiency exhibits certainly a depressive influence on the brain in some of the fetuses in the endemic goiter and cretinism areas retarding its development. This might account for the neurological deficit of cretinism or cretinoid syndrome. 

Thus we couldn t neglect the presence of the "subcretin" yet it is still not so easy to define the term definitely. Like the criteria of endemic cretinism, the subcretin should be associated with endemic goiter and severe iodine deficiency. The characteristics of the subcretin might include ... 

Because of the lack of definite diagnostic criteria and the fact that large scale epidemiological surveys are quite rare, data concerning the relative frequency of endemic cretinism and subcretinism are also varied. We have found in a relatively precise survey in a severe endemia the cretin incidence is 2.56% and that of subclinical individuals 14.8%. 

The first 3 cases (serial nos 604, 638, 515) in the table had hormonal profiles entirely consistent with severe hypothyroidism although these women did not exhibit the clinical features of hypothyroidism In all three cases the pregnancy outcome was a stillblrth/early neonatal death In the succeeding 3 cases (serial nos 568, 245, 430) the maternal total and free thyroxine values were low but triiodothyronine values were within the normal range In one of these the outcome was a stillbirth/early neonatal death and one child has a hearing/speech defect but no other abnormality and, by our definition, cannot be labelled as an endemic cretin ... 

The most dramatic picture of neonatal hypothyroidism due to severe iodine deficiency has been observed in the Ubangi area in Zaire. In this area, the iodine intake is only 15 jLig/day, the prevalence of endemic goiter and cretinism are 76 % and 5 % of the total population respectively. In such extreme conditions, thyroid function in adults is definitely impaired with the classical picture of low serum concentration of T4 and elevated serum TSH andT3 2... 

F. Delange, S. Bastani, M. Benmiloud, et al. Definitions of endemic goiter and cretinism. 

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