(a) Neurological cretinism. This 2007 photograph of a 9-year-old girl from western China demonstrates the three characteristic features: severe mental deficiency together with squint, deaf–mutism, and motor spasticity of the arms and legs. The thyroid is present, and the frequency of goitre and thyroid dysfunction is similar to that observed in the general population. (b) Myxoedematous cretinism. This 2007 photograph of a 5-year-old boy from western China demonstrates the characteristic findings: profound hypothyroidism, severe growth impairment (height, 106 cm), incomplete maturation of the features including the naso-orbital configuration, atrophy of the mandible, puffy features, umbilical hernia, myxoedematous thickened dry skin, and dry hair, eyelashes, and eyebrows. The thyroid typically shows atrophic fibrosis. (See also Fig. 3.2.3.2)