clinical picture Mnemonics of cretinism

Simple Mnemonics for Clinical picture of cretinism

hypothyroid face with protruded tongue

at birth & early neonatal :
1- Feeding difficulty, choking & anorexia
2- Constipation, abdomenal distention, umbilical hernia, delayed passage of meconium
3- Heavy birth weight (Over weight).
4- Hypothermia, cold skin.
5- Open posterior fontanel.
6- Less activity, always sleep, little cry hoarse voice.
7- Prolonged physiological jaundice.
8- Bradycardia: ↓ HR (Slow Pulse) .
9- Apneic attacks: ↓ Respiratory rate.
10- X- Ray knee: absent ossific centers at birth of the lower end of the femur.
APGAR score of early suspicion of hypothyroidism




H → Hypotonia → 1
Y → Yellow (icterus >3) →1
P → Pallor, cold, hypothermia →1
O → Open post. fontanel →1
T → Tongue enlarged →1
H → Umbilical hernia →2
Y → absent Y (female) →1
R → Rough dry skin →1
O → Edematous typical face →2
I.D.→ Inactive defecation → 2
Birth weight > 3.5 kg →1
Post.mature > 40w →1
Total = 15.
If score > 5 suggest hypothyroidism, must investigate.
Typical Symptoms & Signs:

hypothyroidism (short stature and abdominal distension)
A- Delayed growth & development and metal retardation.

• Delayed motor mile stones.
• Delayed social development.
• Growth retardation & short stature .

B- Characteristic features:
1- Head:

•  Face → coarse puffy face.
• Skull → delayed closure of fontanels (anterior).
• Hair → coarse dry hair, low hair line.
• Eyes → hypertdorism, puffy eye lids, scanty hair of brows.
•  Nose → depressed nasal bridge.
•  Tongue → macroglossia, thick lips.
•  Teeth → delayed eruption, tendency to decay.

2- Neck:

• short & webbed. & thyroid may palpable .

3- Skin:

• Pale yellow skin (carotenemia). & Dry, rough, clod.

4- Abdomen:

• Pott's belly abdomen. & Umbilical hernia.

5- C.V.S:

•  Bradycardia.
•  Haemic murmur.
•  Cardiomegally → CHF.

6- C.N.S:

• Hypotonia
• Hyporeflexia,
• apathy.