A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply.

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11ecbb05_ca9e_1198_b433_0759a521436e_MD0009_00 11ecbb05_ca9e_1199_b433_0da41195adab_MD0009_00 Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH and may include: Difficulty awakening, lethargy, or hyporeflexia due to alterations in central nervous system function (Option A) Dry skin due to alterations in skin function (Option B) Hoarse cry caused by swelling of the vocal cords due to fluid retention (Option D) Constipation due to slowed metabolism Bradycardia due to the effect of TH on cardiac function (Options C and E) Hyperthyroidism (Graves disease) is an autoimmune condition related to increased production of TH. Neonatal Graves disease is uncommon and usually occurs secondary to maternal hyperthyroidism. Tachycardia and increased bowel motility (frequent or loose stools) are features of hyperthyroidism and are related to an increase in metabolic processes. Educational objective: Congenital hypothyroidism is a partial or complete loss of thyroid function that affects growth, development, and regulation of bodily functions. Clinical manifestations in affected infants may include dry skin, hoarse cry, or difficulty awakening beginning a few months after birth. If untreated, intellectual disability may occur.

A Nurse Is Caring for a 1-Month-Old Client Who Is