Question

Infant with lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, and large fontanelles. Labs show increased TSH and decreased T4

Answer 1

The infant's symptoms suggest hypothyroidism, a condition characterized by low thyroid hormone levels. Symptoms such as lethargy, poor feeding, constipation, and jaundice can be attributed to hypothyroidism. Lab results showing increased TSH and decreased T4 levels confirm the diagnosis.

Step-by-step explanation:

The infant described in the scenario is presenting with symptoms of congenital hypothyroidism. These symptoms include lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, and large fontanelles. The labs show increased TSH and decreased T4, which are consistent with a diagnosis of congenital hypothyroidism. Congenital hypothyroidism is a condition in which there is inadequate thyroid hormone production in newborn infants. It can occur due to an anatomic defect in the gland, an inborn error of thyroid metabolism, or iodine deficiency. The most common symptoms of congenital hypothyroidism include decreased activity, large anterior fontanelle, poor feeding and weight gain, small stature or poor growth, jaundice, decreased stooling or constipation, hypotonia, and hoarse cry. Infants with primary congenital hypothyroidism typically have low T4 and T3 levels, with elevated TSH and TRH levels due to feedback mechanism to the hypothalamus and pituitary gland. The region of the brain affected in congenital hypothyroidism is the nondominant parietal lobe, which is the left parietal lobe in most right-handed individuals. Treatment with levothyroxine should be promptly initiated for central hypothyroidism.

Answer 2

The symptoms and lab results described suggest that the infant may have congenital hypothyroidism.

The correct answer is (d)

Step-by-step explanation:

Congenital hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormone from birth.

Here's why it is the correct answer:

• 1. Symptoms: The infant in the question exhibits several characteristic symptoms of congenital hypothyroidism, including lethargy (excessive sleepiness or low energy), hoarse cry (due to vocal cord thickening), poor feeding, constipation, jaundice (yellowing of the skin and eyes), dry skin, and large fontanelles (the soft spots on the baby's head).

• 2. Lab Results: The lab results show an increased TSH (thyroid-stimulating hormone) and decreased T4 (thyroxine). In congenital hypothyroidism, the thyroid gland fails to produce enough thyroid hormone, leading to elevated levels of TSH as the body tries to compensate. The low T4 levels further confirm the diagnosis.

• 3. Importance of Thyroid Hormone: Thyroid hormones play a crucial role in the normal growth and development of the body, especially the brain and nervous system. Inadequate levels of thyroid hormone can have significant effects on an infant's physical and cognitive development if left untreated.

• 4. Treatment: Congenital hypothyroidism is managed by replacing the deficient thyroid hormone through lifelong thyroid hormone replacement therapy. Early detection and prompt treatment are essential to prevent long-term complications and ensure normal growth and development.

It's important to note that while other conditions on the list may present with some overlapping symptoms, the combination of symptoms, along with the specific lab findings of increased TSH and decreased T4, strongly points to congenital hypothyroidism as the most likely diagnosis in this case.

The correct answer is (d) Congenital hypothyroidism.

Your question is incomplete, but most probably the full question was:

Infant with lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, and large fontanelles. Labs show increased TSH and decreased T4:

a) Down syndrome

b) Hypoparathyroidism

c) Congenital adrenal hyperplasia

d) Congenital hypothyroidism