Hesperian Health Guides

Hypothyroidism (Cretinism)

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HealthWiki > Disabled Village Children > Chapter 32: Mental Slowness > Hypothyroidism (Cretinism)

Hypothyroidism is a delay in both mental and physical growth that comes when a child’s body does not produce enough ‘thyroid’. Thyroid is a substance, or ‘hormone’, that controls a child’s growth and body functions. Without it, everything goes slower.

illustration of the below: a woman with a goiter

Thyroid is produced by a gland in the front of the neck. To produce thyroid, the gland needs iodine. Most people get enough iodine from water and food. But in some areas, especially in the mountains, the soil, water, and food have very little iodine. In an attempt to obtain more iodine, the thyroid gland sometimes grows very large, forming a swelling called a goiter.

In areas where there is little iodine and a lot of people have goiters, hypothyroidism is common. In these areas, many children have difficulty hearing or are somewhat slow mentally. Although they do not show all the typical signs of hypothyroidism, the cause is probably the same. Occasionally, in areas where goiter is not common, hypothyroidism occurs for other reasons than lack of iodine.

SIGNS Below we show some of the typical signs of hypothyroidism and compare them with Down syndrome, which hypothyroidism resembles in some ways. It is often difficult to tell if a newborn baby has hypothyroidism. She is often born large and then fails to grow normally. The baby may have feeding difficulties, or breathing difficulties or make noises because of the large tongue. She moves and cries little. By 3 to 6 months the mother often becomes worried because the baby looks dull, takes so little interest in things, sleeps so much, and is slow in all areas of development.


  • hair low on forehead
  • puffy eyelids
  • fatty swelling of neck
  • A baby with features indicating hyperthyroidism

  • flat base of nose between eyes
  • puffy face, hands, and feet
  • grows very slowly; increasingly short for age
  • severe constipation (may go days without shitting)
  • often deafness
  • As child grows, knees may get large and painful.
  • temperature below normal
  • thick, dry, cool skin

Signs seen in both HYPOTHYROIDISM and DOWN

  • slow mental and physical development
  • widely separate eyes
  • round face, dull look
  • tongue sticks out of open mouth
  • short neck and limbs; wide, short hands
  • big belly and sway back
  • often hernia of the navel
A boy with an enlarged belly hanging low


(that are most useful in telling it from hypothyroidism)
  • hair starts high on forehead
  • slant eyes with lid fold over inner corners
See other signs.

Boy with features indicating down syndrome

Early and continued treatment with thyroid medicine helps improve growth, physical appearance, and sometimes can reduce or prevent mental slowness. For best results, treatment should begin during the first month of life. As soon as you suspect that a baby might have hypothyroidism, get skilled medical advice.

To help the child develop mentally and physically, and learn basic skills, read Chapters 34 to 41 and use the ideas that can help meet the child’s needs. With early treatment and guided learning, many children with hypothyroidism can learn to care for themselves and do simple but important work in the community. See ideas on managing constipation.


In areas where goiter is common, hypothyroidism (and deafness) can be greatly reduced by encouraging everyone to use iodized salt.

This page was updated:21 Nov 2019