Prompt management of hypothyroidism in infancy is necessary because:

The correct answer is a) Positive Ortolani click, b) Unequal gluteal folds, c) Trendelenburg sign, and e) Telescoping of the affected limb.

Choice A reason:

A positive Ortolani click is a clinical manifestation of developmental dysplasia of the hip (DDH). The Ortolani maneuver is used to detect hip dislocation or subluxation in infants. When the hip is abducted and gentle pressure is applied to the proximal thigh from behind, a palpable “clunk” is noticed as the femoral head relocates into the acetabulum. This indicates hip instability, which is a characteristic of DDH.

Choice B reason:

Unequal gluteal folds are another clinical manifestation of DDH. Asymmetrical gluteal creases can suggest hip dysplasia in infants. This is because the dislocation or subluxation of the hip can cause one leg to appear shorter than the other, leading to uneven gluteal folds.

Choice C reason:

The Trendelenburg sign is a clinical test used to assess the integrity and strength of the hip abductor muscles, particularly the gluteus medius and gluteus minimus. A positive Trendelenburg sign usually indicates weakness in these muscles, which can be associated with hip abnormalities such as congenital hip dislocation3. In DDH, the hip instability can lead to a positive Trendelenburg sign.

Choice D reason:

A negative Babinski sign is not a clinical manifestation of DDH. The Babinski reflex is a normal reflex in infants up to 2 years old, where the big toe moves upward and the other toes fan out when the sole of the foot is stroked. A negative Babinski sign would indicate the absence of this reflex, which is not related to DDH.

Choice E reason:

Telescoping of the affected limb is a clinical manifestation of DDH. In a child with DDH, the hip socket is shallow, and the head of the femur may slip in and out, leading to a telescoping effect. This means the femoral head can move further out of the socket, causing the limb to appear shorter or longer depending on the position.

Choice A reason:

Weight gain is not a primary concern in the management of hypothyroidism in infancy. While hypothyroidism can lead to weight gain due to a slower metabolism, the more critical issue is the impact on brain development. Early and adequate treatment of hypothyroidism is essential to prevent intellectual disabilities and ensure normal neurocognitive outcomes.

Choice B Reason:

Rapid gut motility and diarrhea are not typical symptoms of hypothyroidism. In fact, hypothyroidism is more commonly associated with constipation due to a slower metabolism. Therefore, this choice is not relevant to the prompt management of hypothyroidism in infancy.

Choice C Reason:

Infancy is indeed a critical period for brain development. Untreated hypothyroidism during this time can lead to severe intellectual disabilities and developmental delays. Early diagnosis and treatment with thyroid hormone replacement are crucial to ensure normal brain development and cognitive function.

Choice D Reason:

Hyperactivity and irritability are not common symptoms of hypothyroidism. In fact, hypothyroidism often leads to lethargy and decreased activity levels. Therefore, this choice is not relevant to the prompt management of hypothyroidism in infancy.