Congenital hypothyroidism, which can be genetic, sporadic or endemic, is a condition of severely stunted physical and mental development, caused by a deficiency of the hormone thyroxine. In the UK around one in every 3,500 to 4,000 children are born with congenital hypothyroidism. Similar rates are reported in the USA and continental Europe. It is more common in girls than in boys, but the reason for this is currently unknown.
Without treatment, adult stature is below average, ranging from 1 to 1.6 metres; bone maturation and puberty are severely delayed and infertility is common. Neurological impairment, of varying degrees of severity, is to be expected. Cognitive development, thought and reflexes are slower. Other signs of the condition may include thickened skin, enlarged tongue or a protruding abdomen.
Fortunately, genetic and sporadic congenital hypothyroidism, caused by abnormal development of the thyroid gland before birth, has been almost completely eliminated in developed countries by newborn-screening schemes and lifelong treatment.
The endemic condition arises from a diet deficient in iodine: the essential trace element that the body needs to produce thyroid hormones. The soils of many inland areas on all continents are iodine deficient and food produced there is correspondingly deficient. Iodine deficiency causes gradual enlargement of the thyroid gland, and the resulting growth is referred to as a goitre. The endemic form of the condition continues to be a major public-health problem in many undeveloped countries.
‘Cretin’, from an Alpine-French dialect spoken in a region where sufferers were especially common, became a medical term in the eighteenth century. It saw considerable medical use in the nineteenth and early twentieth centuries, and then spread more widely in popular English as a derogatory term for someone who behaves stupidly. Because of its pejorative connotations in popular speech, health-care workers have mostly now ceased use of the term.
Acknowledgements
One of the most rewarding aspects of writing is the opportunity to learn, and the following taught me a lot: A History of Psychiatry by Edward Shorter; Basic Child Psychiatry by Philip Barker; Crime Scene to Court: the Essentials of Forensic Science edited by P. C. White; Postmortem: Establishing the Cause of Death by Dr Steven A. Koehler and Dr Cyril H. Wecht; and Practical Church Management by James Behrens.
Avril Neal, Jacqui and Nick Socrates, Denise Stott and Adrian Summons continue to do sterling work, not only reading and correcting my early manuscripts but also patiently providing advice and information throughout the writing process. Dr Miraldine Rosser joined ‘the team’ this year, and her help in making Evi a credible psychiatrist was invaluable. Thank you, all of you, and as always, any remaining mistakes are mine.
The folk at Transworld continue to be supportive, encouraging, hardworking and wise. I’m particularly grateful to Sarah Turner, Laura Sherlock, Lynsey Dalladay, Nick Robinson and Kate Samano. In the US, my thanks as ever to Kelley Ragland and Matthew Martz of Minotaur Books.
As for Anne-Marie, Rosie, Jessica and Peter: it simply would not be the same without you.
S. J. Bolton
S. J. Bolton was born in Lancashire. She is the author of two previous critically acclaimed novels, Sacrifice and Awakening, out now in paperback. Sacrifice was nominated for the International Thriller Writers Award for Best First novel and, in France, for the prestigious Prix Polar SNCF Award. The Blood Harvest is her third novel. She lives near Oxford with her husband and young son.
For more information about the author and her books, visit her website at www.sjbolton.com
