Thyroid replacement therapy in Down's syndrome with hypothyroidism

Three elderly subjects with Down's syndrome and biochemical evidence of hypothyroidism were investigated before and after four months of thyroid replacement treatment. The patients' appearance was demonstrated by photographs and the biochemical thyroid values and the intellectual performance were assessed. The appearance before treatment varied from a florid myxoedematous appearance to a state without features indicating myxoedema. Thyroid replacement therapy was given in usual dose and the biochemical response was similar to that seen in normal subjects. The intellectual performance improved little or not at all. The characteristic discomfort usually associated with hypothyroidism was very pronounced in one case and disappeared totally during treatment. It is concluded that the diagnosis of hypothyroidism in elderly subjects with Down's syndrome can be very difficult when based on appearance and history alone and biochemical thyroid tests are often necessary. The patients should be treated with replacement therapy just as other patients suffering from hypothyroidism.