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Thyroid function has been studied in 11 middle-aged and elderly subjects with proven Down syndrome. Unequivaocal biochemical evidence of hypothyroidism was found in 6, and of thyrotoxicosis in 1. It is concluded that, in contrast to the situation in children with Down syndrome, thyroid dysfunction is exceedingly common in adults with the syndrome.

Three patients with bleeding tendency who met the criteria for type 1 von Willebrand's disease are described. In two patients, hypothyroidism was suspected and confirmed at presentation, and in the third hypothyroidism became apparent 4 years later. In all three, the history and clinical course after treatment with thyroxine indicated acquired von Willebrand's disease secondary to hypothyroidism. The possibility of hypothyroidism should be considered in patients presenting with von Willebrand's disease.

Effusions into body cavities secondary to hypothyroidism, though rare, are well recognised. They may precede the more specific and typical manifestations of the disease, thereby misleading the clinician.

A 60-year-old woman presented with deteriorating vision. A computed tomography (CT) scan showed pituitary enlargement with chiasmal compression. Serum prolactin levels were normal but assessment of thyroid function showed a serum thyroxine level of 25 nmol/l (normal range 76-160 nmol/l) and a thyroid-stimulating hormone (TSH) level of 60 mU/l (normal range 0.5-5.0 mU/l). After 8 weeks of thyroxine replacement therapy (0.05 mg daily increasing to 0.1 mg daily after 3 weeks) the visual defects had resolved, serum TSH had fallen to 0.7 mU/l, and the CT scan showed pronounced reduction in the size of the pituitary gland. Measurement of TSH as well as prolactin is essential in all patients with pituitary enlargement, to avoid unnecessary pituitary surgery.

In a population-based screen of 617,913 infants, primary congenital hypothyroidism (CH) was confirmed in 100 children. 32 of the 100 infants with CH had an additional defect or complication. In the group with CH the rates of congenital heart disease, non-cardiac malformations, respiratory distress syndrome, and death were higher than in the general population of the same age. Black infants were less likely than whites to have CH, but were at twice the risk of additional impairment. Infants with CH who had an additional complication were screened (12.7 vs 4.8 days) and treated (32.4 vs 19.7 days) significantly later than those infants with isolated CH. Congenital malformations and neonatal complications should not be reasons for deferring screening for CH.