This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endocrinology, Subject name: Pediatrics
Clinical manifestations of hoarse cry, umbilical hernia, hypotonia, mottling of skin, lethargy, prolonged jaundice is seen in: 
Select and explain. 
A. Gaucher's disease, B. Mucopolysaccharidosis, C. Growth hormone deficiency, D. Congenital hypothyroidism
D: Congenital hypothyroidism
Answer: D: Congenital hypothyroidism 
Explanation: d. Congenital hypothyroidism(Ref: Nelson's 20/e p 2669-2773, Ghai 8/e p 516-521)The given clinical features, i.e. hoarse cry, umbilical hernia, hypotonia, mottling of skin, lethargy, prolonged jaundice suggest a diagnosis of congenital hypothyroidismClinical Features of Congenital Hypothyroidism:Thyroid dysgenesis presents at birth; ectopic thyroid usually presents late10-15% of cases due to inborn errors of thyroid hormone synthesis and often present after infancyOne of the earliest signs of congenital hypothyroidism is patent posterior fontanele and wide open cranial sutures.Umbilical hernia, constipation, hypothermia, feeding difficulty, breathing difficulty, prolonged physiological jaundice and hypotoniaMuscles are usually flaccid and hypotonic except in one variant, Kocher-Debre-Semelaigne syndrome, where muscles (esp calf muscles) are hypertrophied; returns to normal with treatmentsDentition is delayed and DTR slow relaxation; refractory anemia is common.