Congenital hypothyroidism

Last revised by Dr Ammar Ashraf on 05 Jan 2022

Congenital hypothyroidism (CHT), previously known as cretinism, can be of thyroidal or central (hypothalamic/pituitary) origin and can have a widely diverse molecular etiology.

Most children are asymptomatic at birth and are diagnosed after screening. In untreated congenital hypothyroidism, patients can present with short stature, disproportionately enlarged heads and/or developmental delay / intellectual disability 5.

  • disorders in development of the thyroid gland
    • thyroid is absent
    • underdevelopment with migration failure
    • underdevelopment with normal migration
    • certain fetal goiters can also give hypothyroidism 4
  • disorders in thyroid hormone synthesis
    • TSH hyporesponsiveness
    • defects in iodide transport from circulation into the thyroid
    • defects in iodide transport from the thyroid cell to the
      follicular lumen, often combined with inner ear deafness
      (Pendred syndrome)
    • defects in the synthesis of hydrogen peroxide
    • defects in the oxidation of iodide, iodination and
      iodothyronine synthesis
    • defects in processes involved in the synthesis or degradation of thyroglobulin
    • detects in iodine recycling
  • central congenital hypothyroidism
    • disorders in development and/or function of the
      • hypothalamus
      • pituitary gland
      • both
  • delayed skeletal maturation
  • bone epiphyses/ossification centers are absent or small
    • stippled epiphysis appearance
  • cortical thickening

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Cases and figures

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  • Case 4
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