OSCE — Congenital Hypothyroidism

Brief (to candidate)

You will assess a patient with a presentation consistent with Congenital Hypothyroidism.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Congenital hypothyroidism (CH) is thyroid hormone deficiency present at birth, resulting from abnormal thyroid gland development (dysgenesis, about 80%) or inborn errors of hormone biosynthesis (dyshormonogenesis, about 15 to 20%), with a minority due to transient maternal or environmental causes. Affected neonates are usually asymptomatic at birth because maternal thyroxine crosses the placenta; untreated, the disease produces irreversible intellectual disability, short stature and developmental delay, making CH the most common preventable cause of intellectual disability worldwide. Universal newborn screening (TSH on a heel-prick dried blood spot) detects CH before symptoms, and immediate

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.