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A Listless Baby: by Dr.Munawar Aziz

I remember a person from the Kohistan area of Hazara Division who brought a listless two-year-old female child to my clinic in the year 2003. She had a thick protruding tongue, heavy lips, and could hardly open her eyes, let alone cry, laying helplessly on the examination couch where her father had put her.

The father mentioned that she couldn’t sit, hold her head, or cry. She simply lay down and took very little milk when fed. Their socioeconomic history revealed their struggle to afford even two meals a day.

They borrowed money from relatives for the child’s examination and treatment. I suspected cretinism—a condition caused by iodine deficiency leading to inactive thyroid in childhood, and considering their inability to afford a thyroid function test or my fee (which I waived), I started the girl on empiric thyroxin 50 micrograms and asked them to return after a month.

To my surprise and joy, when they revisited after four weeks, the girl was sitting on her own, responsive to touch, and appeared more active. Her father mentioned her gradual improvement. Last time she visited me in 2020, she was on 200 micrograms of thyroxin—a grown-up girl studying in school. She came to thank and bid farewell as her father had found a job in Karachi.

Cretinism, primarily caused by severe iodine deficiency during pregnancy or infancy, leads to stunted physical growth and intellectual impairment. This disorder affects thyroid function, hindering hormone production necessary for proper development. Children with cretinism face challenges such as cognitive disabilities, delayed physical growth, and sometimes hearing and speech impairments. The severity of symptoms varies based on the degree of hormone deficiency and early diagnosis.

Treatment primarily involves thyroid hormone replacement therapy to supplement deficient hormones and support normal growth and development. Without timely intervention, irreversible damage to both physical and mental capabilities can occur.

Prevention remains crucial. Efforts to ensure adequate iodine intake among pregnant women through dietary adjustments or supplements significantly reduce the risk of cretinism in newborns. While living conditions in the hilly areas of Pakistan have improved, and iodine deficiency is relatively rare, vigilance is important for patients from those remote areas.

*Dr.Munawar Aziz.MCPS


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