<prompt> Common presentations of Juvenile HypothyroidismGrowth retardationMental ratardation within 2 yearsUmbilical HerniaAll of these  <response>: Features of juvenile congenital hypothyroidism are :Open posterior fontanel and wide suturesLarge tongue Can cause respiratory difficultiesRough dry skin which is cool mottledHypotonia, large abdomen, flaccid musclesSleepy, little cry, poor feed chocking spells during feeding.Short neck with a thick supraclavicular pad of fat may be present. Marked physical mental retardation, delayed social smile.Short stature, normal head size with short extremities.Delayed relaxation of deep tendon reflexes.An umbilical herniaEdematous, characteristic faciesConstipationPallor, hypothermiaSexual precocity occasionallyRefractory anaemia commonDelayed dentitionOpen mouth with protuberant tongueSlow pulse, cardiomegaly Heart murmur.Prolongation of physiological jaundice due to delayed maturation of glucuronide conjugation.Clinical features of acquired hypothyroidism Growth retardationDisproportionately large head and trunk as compared to limbsIncreased upper and lower body segment ratioGross mental retardation is not usually presentDelayed skeletal maturationDelayed dental developmentPuffy faceLethargyCold intoleranceDelayed pubertyMyopathyPseudotumor cerebriNote: In congenital hypothyroidism there is hypotonia. Rarely the muscle may appear hypertrophied pseudohypertrophy with an athletic appearance Kocher-Debre-Semelaigne syndrome gives infant Hercules appearance. 