Common presentations of Juvenile Hypothyroidism –

Features of juvenile (congenital) hypothyroidism are : Open posterior fontanel and wide sutures Large tongue → Can cause respiratory difficulties Rough dry skin which is cool & mottled Hypotonia, large abdomen, flaccid muscles Sleepy, little cry, poor feed & chocking spells during feeding. Short neck with a thick supraclavicular pad of fat may be present.  Marked physical & mental retardation, delayed social smile. Short stature, normal head size with short extremities. Delayed relaxation of deep tendon reflexes. An umbilical hernia Edematous, characteristic facies Constipation Pallor, hypothermia Sexual precocity occasionally Refractory anaemia common Delayed dentition Open mouth with protuberant tongue Slow pulse, cardiomegaly & Heart murmur. Prolongation of physiological jaundice due to delayed maturation of glucuronide conjugation. Clinical features of acquired hypothyroidism  Growth retardation Disproportionately large head and trunk as compared to limbs Increased upper and lower body segment ratio Gross mental retardation is not usually present Delayed skeletal maturation Delayed dental development Puffy face Lethargy Cold intolerance Delayed puberty Myopathy Pseudotumor cerebri Note: In congenital hypothyroidism there is hypotonia. Rarely the muscle may appear hypertrophied (pseudohypertrophy) with an athletic appearance → Kocher-Debre-Semelaigne syndrome gives infant Hercules appearance.