• Untreated CH results in mental retardation, hence, it is assumed that juvenile hypothyroidism also results in poor school performance and intellectual delay. The fact is that there are no learning problems or intellectual delay or cognitive impairment. The diagnosis may be elusive.• Adolescent hypothyroidism is most commonly autoimmune thyroiditis and may be detected only with growth failure in chronic hypothyroidism.• Hashimoto thyroiditis is typically seen in adolescents, rarely in younger age.• Avoid overdiagnosis, unwarranted treatment. Before advising lifelong thyroxine treatment, confirm data, diagnosis and etiology.• Hasty decisions are unjustified. Long-term thyroxine shall surely shrink and fibrose the normal functioning thyroid.• We should not create hypothyroidism.• Delay in treatment of CH will results in developmental delay.• Neonatal thyroid screening is essential for detecting congenital hypothyroidism.