This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
8 years. old child presents with lethargy multiple epiphyseal breaks, wormian bones with growth retardation and mental retardation Diagnosis is – 
Select and explain. 
A. Rickets, B. Hypothyroidism, C. Scurvy, D. Hypoparathyroidism
B: Hypothyroidism
Answer: B: Hypothyroidism 
Explanation: Multiple epiphyseal breaks, wormian bones with lethargy, growth retardation and mental retardation suggest the diagnosis of hypothyroidism.

X-ray findings of hypothyroidism 

Delayed appearance of epiphysis
Multiple foci of ossification → Epiphyseal dysgenesis
Epiphyseal breaking of 12th thoracic and 1st or 2nd lumbar vertebrae.

Skull → 

Large fontanelle
Wide sutures
Wormian bones
Enlarged & rounded sella turcica


Delayed dentition