Historical aspects of iodine deficiency control.

In 1895, iodine was characterized as an essential element of thyroid tissue by Baumann. The efficacy of iodine to prevent goiter was demonstrated by Marine in Northern USA in 1916-1920. Severe endemic goiter and cretinism had been almost entirely eliminated from continental Western Europe and Northern America before the 1930's; however large populations elsewhere and even some places in Western Europe (Sicily) were still affected up to the 2000's. Public health consequences of iodine deficiency are not limited to endemic goiter and cretinism. Iodine deficiency disorders include also increased neonatal death rate and decreased intellectual development, although these consequences are not included in the current estimation of the Global Burden Disease related to iodine deficiency. Severe iodine deficiency as a public health problem is now largely under control worldwide, but can still affect isolated places, in hard-to-reach and/or politically neglected populations. We emphasize the importance of maintaining international cooperation efforts, in order to monitor iodine status where iodine deficiency is now adequately controlled, and identify at-risk population where it is not. The goal should be now global eradication of severe iodine deficiency. Commercial distribution of iodized salt remains the most appropriate strategy. A randomized clinical trial in New Guinea clearly showed in the 1970's that correcting severe iodine deficiency early in pregnancy prevents endemic neurological cretinism. This supports the essential role of thyroid hormones of maternal origin on the normal fetal development, during the first trimester of pregnancy (i.e. when fetal thyroid is still not functional). A randomized clinical trial in Congo (RD) in the 1970's also showed that correcting severe iodine deficiency during pregnancy prevents myxœdematous cretinism, particularly prevalent in affected Congolese areas.

More on the Liang Bua finds and modern human cretins.

Brown (2012: LB1 and LB6 Homo floresiensis are not modern human (Homo sapiens) cretins, Journal of Human Evolution) makes errors of fact, omission and interpretation. Brown's comments refer, among others, to (1) delayed growth and development indicated by unfused epiphyses, (2) postcranial limb proportions: limbs to trunk, between limbs, and within limbs, (3) postcranial bone torsions and angles, (4) postcranial robusticity, real and apparent, (5) skull features, and (6) cretinism on Flores. In each of these areas, much information about cretins is incorrect and much information (Oxnard et al., 2010) comparing the Liang Bua remains with cretins is ignored.

Are the small human-like fossils found on Flores human endemic cretins?

Fossils from Liang Bua (LB) on Flores, Indonesia, including a nearly complete skeleton (LB1) dated to 18kyr BP, were assigned to a new species, Homo floresiensis. We hypothesize that these individuals are myxoedematous endemic (ME) cretins, part of an inland population of (mostly unaffected) Homo sapiens. ME cretins are born without a functioning thyroid; their congenital hypothyroidism leads to severe dwarfism and reduced brain size, but less severe mental retardation and motor disability than neurological endemic cretins. We show that the fossils display many signs of congenital hypothyroidism, including enlarged pituitary fossa, and that distinctive primitive features of LB1 such as the double rooted lower premolar and the primitive wrist morphology are consistent with the hypothesis. We find that the null hypothesis (that LB1 is not a cretin) is rejected by the pituitary fossa size of LB1, and by multivariate analyses of cranial measures. We show that critical environmental factors were potentially present on Flores, how remains of cretins but not of unaffected individuals could be preserved in caves, and that extant oral traditions may provide a record of cretinism.

On the way to a scientia sexualis: 'On the relation of the sexual system to the psyche in general and to cretinism in particular' (1826) by Joseph Häussler.

At the beginning of the nineteenth century, several works were published by physicians trying to explain, in an increasingly systematic manner, the emergence of psychic derangements with sexual disorders. A contribution to this development was provided by Joseph Häussler with his monograph 'On the relation of the sexual system to the psyche in general and to cretinism in particular' (1826). Häussler was interested in whether the sexual system was the cause of psychic disturbance. He accused some sexual behaviours and exercises (e.g., onanism and unsatisfied sexual instinct) of being causes, but, nonetheless, accepted that morphological deviations of the sexual organs could also evoke mental diseases. Furthermore Häussler attempted to determine if stimulation of the sexual system could cure psychic illnesses. Finally, he dealt with sexual conditions in the mentally ill. A complete chapter was devoted to cretins and their sexuality.

[A small jade figure from the Olmecan culture]. / Reflexiones sobre una pequeña figurilla Olmeca de jade.

In this paper some reflections motivated by a prehispanic Olmec stone sculpture that was found in the Mexican state of Veracruz by 1940, are presented. This small figure of the prehispanic art, could be the representation, this is "a portrait", of a person with similar features to those present in patients with congenital hypothyroidism. This features include short stature, coarse face, eyelid edema and expression of the mental retardation, so this would be one more example of the acute clinical observation of ancient Mexicans and maybe a testimony of a continuous prevalence from remote times until nowadays of a defect that put a lot of human beings in great disadvantage, disability that has almost disappear thanks to neonatal screening.

Iodine and neuropsychological development.

The establishment of the essential link among iodine deficiency, thyroid function and brain development has emerged from a fascinating combination of clinical, epidemiologic and experimental studies. The central human phenomenon that focuses this relationship is the condition of endemic cretinism, described from the Middle Ages and characterized in its fully developed form by severe brain damage, deaf mutism and a spastic state of the hands and feet. The demonstration of the prevention of cretinism in a double-blind controlled trial with injections of iodized oil in Papua New Guinea (1966-1970) established the causal role of iodine deficiency in cretinism by an effect on the developing fetal brain. Cretinism could not be prevented unless the iodized oil was given before pregnancy. Iodine deficiency is now regarded by the WHO as the most common preventable cause of brain damage in the world today, with at least 30 million suffering from this preventable condition. Since 1986 the international NGO, the International Council for Control of Iodine Deficiency Disorders, has worked closely as an expert group with WHO and UNICEF in assisting countries with a program of universal salt iodization for the elimination of iodine deficiency as a cause of brain damage by the year 2000. In 1996, WHO reported that 56% of the population of 83 developing countries now had adequate access to iodized salt. This represents an increase of 750 million since 1990 with protection of 12 million children.