THE JOURNAL OF PEDIATRICS � www.jpeds.com Vol. 163, No. 5

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50 Years Ago in THE JOURNAL OF PEDIATRICS

The Development of Children with Congenital Hypothyroidism. A Note onEarly, Temporary Replacement Therapy for 2 Goitrous InfantsMan EB, Mermann AC, Cooke RE. J Pediatr 1963;63:926-41

Man et al describe in detail the intellectual and physical development of 23 children with congenital hypothyroid-ism (CH), correlating this with age at initial treatment and dosage of thyroid hormone replacement therapy.

Early therapy, continued throughout childhood, and higher doses were associated with the best long-term prognosis.Although previous, larger studies had shown improved prognosis, the series by Man et al is the first one in which theadequacy of thyroid hormone replacement is verified and guided by an objectivemeasure, the serum extractable iodineconcentration.

In the five decades that followed this series, CH was recognized as a major, preventable cause of mental retardationand became one of the success stories of modern public health programs. Worldwide, the most common cause of CHremains maternal iodine deficiency, leading to hypothyroidism and severe mental retardation in the child. Indeveloped countries, CH is caused by agenesis, dysgenesis, or ectopic development of the thyroid gland. Neonatalscreening programs evolved over the past 30 years from local pilot testing to being performed in most countries inthe world. Measurement of thyroid stimulating hormone or T4 values in the first 48 hours of life allows for earlydiagnosis, which, coupled with early, aggressive treatment, and monitoring lead to eradication of mental retardationand clinical sequelae of CH.1

Diana E. Stanescu, MDDivision of Endocrinology and Diabetes

Department of PediatricsThe Children’s Hospital of Philadelphia

Philadelphia, Pennsylvaniahttp://dx.doi.org/10.1016/j.jpeds.2013.05.018

Reference

1. Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, et al. Update of newborn screening and therapy for congenital hypothy-

roidism. Pediatrics 2006;117:2290-303.

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