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The study by Hulse' on children with congenital hypothyroidism provides useful retrospective data and prompts us to compare his findings with our own study in the northern region.2 In a subgroup of 43 children we found a similar intelligence quotient (IQ) distribution (mean (SD) Weschler intelligence scales for children-revised (WISC-R) 82-4 (17-7)) and an association between IQ and social class. There was a trend to delayed diagnosis, however, in the lower social classes and lower IQ scores in those with severe bone age delay. The lower mean IQ scores in this and in Hulse's study compared with that of Macfaul3 could be the result of a difference in the social class distribution and in the degree of thyroid deficiency but it could also be due to the different tests used: WISC-R can give values about six points lower than those of the WISC test.4 We have also studied 43 adults with congenital hypothyroidism. Their IQ score was mean (SD) 92-2 (15-1) (Weschler adult intelligence scales test), but we found an 10 gain of mean 10-6 (5.4) in 16 of these adults who had been tested 10 years apart. This confirms that the IQ score of some patients may continue to increase with age even allowing for IQ test differences. Coordination problems identified by using standardised motor assessment were common both in adults and children. We used the Bruinink's-Oseretsky test battery2 in the children and we recommend this test for prospective studies of children diagnosed by screening. Hulse' showed inappropriate treatment in some patients. In our study, 50% of the children were on doses of thyroxine higher and 20% on doses lower than recommended. Interestingly, although many had abnormal serum thyroxine and thyroid stimulating hormone values, few had any symptoms. presumably as a result of the protective effects of reverse triiodothyronine and triiodothyronine.5 Some of those with high serum thyroxine values, however, had bone ages advanced by two years or more. This emphasises the need to observe treatment recommendations in patients diagnosed early in order to avoid complications such as craniostenosis, and to ensure optimal subsequent clinical progress.

Outcome for congenital hypothyroidism.