This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Diseases of Thyroid, Subject name: Medicine
What is the most common presentation of congenital hypothyroidism? 
Select and explain. 
A. Prolongation of physiological jaundice, B. Wide open posterior fontanelle, C. Enlarged tongue and feeding problems, D. Asymptomatic at bih
D: Asymptomatic at bih
Answer: D: Asymptomatic at bih 
Explanation: Most commonly infants with congenital hypothyroidism are asymptomatic at bih Few cases present with prolongation of physiological jaundice, feeding issues, hypotonia, enlarged tongue and umbilical hernia which are now diagnosed by biochemical screening. Permanent neurological damage may occur if it is left untreated. Cardiac and other congenital malformations are also more common in these infants.Heel prick test is done on day 3 of life onwards and levels of TSH and T4 are measuredto detect asymptomatic congenital hypothyroidism.