Thyroid hormones are important for normal development of the human central nervous system (CNS). It is well established in children with congenital hypothyroidism that neonatal thyroid hormone deficiency significantly impairs subsequent neurodevelopment. In these children, the period of thyroid hormone insufficiency, which can begin in utero and extend until thyroid status is restored to normal in the neonatal period, determines the severity and type of defect manifested. While prompt and optimal thyroid hormone supplementation, following newborn screening is associated with far improved outcome and near normal development, subtle specific neurodevelopmental differences are still detectable compared to euthyroid controls. Because the particular impairments reflect the exact period of thyroid hormone insufficiency postnatally, as well as during gestation, this implies that brain development is not only thyroid hormone dependent in the neonatal period, but also prior to birth.