Congenital hypothyroidism and thyroid-stimulating hormone (TSH)deficiency at an early age are the major causes of cretinism. A child with hypothyroidism has insidious changes that could include all the following except:

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Cretinism, resulting from congenital hypothyroidism or TSH deficiency, typically presents with symptoms such as a croaky voice, bradycardia, and periorbital puffiness due to the overall slowing of metabolic processes. Hyperreflexive deep tendon reflexes are not associated with hypothyroidism; instead, hypothyroidism is more likely to cause delayed reflexes or hyporeflexia due to the slowed relaxation phase of the reflex.

Congenital Hypothyroidism and Thyroid-Stimulating Hormone (TSH)deficiency at an Early Age