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Dental Management of the Medically Complex Patient > Endocrine Diseases > Flashcards

Endocrine Diseases Flashcards

1
Q

diabetes is related to:

A

lack of beta cell pancreatic production of insulin

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2
Q

insulin is needed for:

A

sugar absorption into cells

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3
Q

a lack of insulin leads to:

A

increased serum glucose aka hyperglycemia

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4
Q

hyperglycemia results in:

A

undernourished tissues which have multiple effects on systemic health

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5
Q

gestational diabetes occurs in what percentage of pregnancies

A

2-10%

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6
Q

is type I diabetes insulin dependent, another name for it and what percentage of diabetics have it

A
  • aka juvenile diabetes
  • insulin dependent
  • 10-20% of diabetics
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7
Q

describe type 1 diabetes and who it affects

A
  • autoimmune disease
  • destruciton of pancreatic Beta cells -> insulin deficiency
  • non-obese children and adults less than 40 years old
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8
Q

what stage of type 1 diabetes do symptoms occur

A

stage 3

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9
Q

what are the effects of diabetes

A
  • microvascular
  • macrovascular
  • impaired wound healing and susceptibility to infection
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10
Q

what are the microvascular effects on diabetes

A
  • neuropathy- extremities, impotence, bladder dysfunction, gastroparesis
  • retinopathy- cataracts, blindness
  • nephropathy
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11
Q

what are the macrovascular effects of diabetes

A
  • peripheral vascular disease, congestive heart failure- hypertension
  • myocardial infarction- diabetes accelerates atherosclerosis
  • stroke
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12
Q

what are the impaired wound healing and susceptibility to infection effects of diabetes

A
  • neutrophilic dysfunction, increased M1:M2 ratio
  • increased pro-inflammatory cytokines and increased MMPs
  • impaired angiogenesis and endothelial dysfunction
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12
Q

describe type 2 diabetes

A
  • aka adult onset diabetes; non insulin dependent
  • pancreas produces insulin but it is in low titers or it does not work properly
  • 80-90% of diabetics
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12
Q

what is the normal, pre-diabetes and type 2 DM fasting plasma glucose

A
  • less than 100mg/dl
  • 100-135 mg/dl
  • greater than 126 mg/dl
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12
Q

what is the normal, pre-diabetes and type 2 DM 2 hour plasma glucose

A
  • less than 140 mg/dl
  • 140-199 mg/dl
  • greater than or equal to 200mg/dl
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13
Q

what is HbA1C levels for normal, pre diabetes, and type 2 DM patients

A
  • less than 5.7%
  • 5.7-6.4%
  • greater or equal to than 6.5%
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14
Q

describe what A1C measures

A
  • measures the glycosylation of HbA aka HBA1C
  • glycated hemoglobin test
  • glycosylated hemoglobin test
  • glycohemoglobin test
  • a stable measure not affected by every day glucose fluctuation
  • can be tested every 3 months
  • biannual testing is recommended for prediabetes and susceptible pateints
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15
Q

what is the goal for capillary plasma glucose prior to meals

A
  • 80-130 mg/dl
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16
Q

what is the goal for the capillary plasma glucose 1-2 hour after a meal

A

less than 180 mg/dl

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17
Q

what is the goal for hemoglobin A1C in patients without kidney disease or other significant comorbidities

A

less than 7%

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18
Q

what is the goal for hemoglobin A1C in pateints on dialysis less than 50 years of age

A

7-7.5%

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19
Q

what is the goal for hemoglobin A1C in pateints greater than 50 years old

A

7.5-8%

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20
Q

what HbA1C is associated in perio disease in poorly controlled diabetics

A

over 9%

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21
Q

is there a correlation between severity of periodontitis and retinopathy

A

yes

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22
Q

periodontitis + diabetes ->

A

more renal complications and cardiovascular complications

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23
Q

severe periodontitis has an association in diabetes with:

A

neuropathic foot ulceration

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24
Q

what are the types of medications that are prescribed for diabetes

A
  • decrease in gluconeogenesis
  • increase in insulin secretion
  • sensitization to insulin
  • decrease in glucagon secretion
  • intestinal and renal absorption of glucose
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25
Q

what are the medications that cause a decrease in gluconeogenesis

A
  • biguanide- metformin
  • insulin - rapid- lispro, short - novolin, long acting- glargine
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26
Q

what are the medications that cause an increase in insulin secretion

A
  • sulfonylureas- glipizide, chlorproamide, tolbutamide
  • glucagon- like peptide (GLP1) receptor agonist- exenatide, liraglutide
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27
Q

what are the meds that cause a sensitization to insulin

A

-thiazolidinediones- pioglitazone

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28
Q

what are the medications that cause a decrease in glucagon secretion

A
  • dipeptidyl peptidase 4 (DPP4) - sitagliptin
  • GLP1 receptor agonist - exanatide, liraglutide
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29
Q

what are the meds that are prescribed for intestinal and renal absorption of glucose

A
  • sodium glucose cotransporter 2 inhibitors - canaglifozin
  • alpha- glucosidase inhibitor- acarbose
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30
Q

what are the most common type of medication prescribed in diabetes

A

meds that cause a decrease in gluconeogenesis

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31
Q

what are the side effects of diabetes meds

A
  • xerostomia/dry mouth
  • oral burning
  • infections (bacterial, fungal, viral)
  • poor wound healing
  • increased carries
  • increased severity risk of perio disease
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32
Q

which type of infection is an indicator that diabetes isnt being controlled well

A

fungal

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33
Q

what are the concerns with diabetics

A
  • if 2 hour after meal glucose, or fasting glucose reading less than 70 or more than 200mg/dl or hba1c over 8%
  • if patient is not being closely followed by physician or more than 6 months seeing physician
  • prophylactic antibiotics is context dependent
  • defer elective tx
  • if emergency or active infection refer to hospital or specialist
  • send med consult
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34
Q

what comorbidities with diabetes need to be controlled

A
  • HTN
  • HLD
  • other cardiovascular disease (angina, MI, CHF, stroke)
  • renal impairment
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35
Q

what medications need to be avoided in diabetes and what do they cause

A
  • tetracycines (including doxycyclines) with insulin - hypoglycemia
  • fluoroquinolones - ciprofloxacin (cipro), levofloxacin (levaquin) with insulin - hypoglycemia
  • aspirin with sulfonylureas - hypoglycemia
  • sulfonylureas may cause thrombocytopenia
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36
Q

what should early morning appointments with diabetics consider

A
  • eat normal meal and take meds prior to appointment
  • be aware of and have patient communicate symptoms of hypoglycemia
  • have high concentrations sugar products readily available- orange juice, cake icins, soft drinks
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37
Q

is oral sedation recommended with diabetics , why or why not

A
  • no because fasting is necessary
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38
Q

which questions should you ask once you know your patient is diabetic

A
  • previous hospitalizations
  • drug interactions/side effects
  • disease control
  • ability to tolerate care
  • comorbidities
  • infection
  • disease duration
  • disease complications
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39
Q

what percentage of pregnancies does gestational diabetes occur in and when does it present

A
  • 2-10% of pregnancies
  • presents at mid-term ~24-28 weeks
  • unknown etiology
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40
Q

how long is each trimester of pregnancy

A
  • first trimester: 0-12 weeks
  • second trimester: 13-28 weeks
  • third trimester: 29-40 weeks
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41
Q

what is early term, full term, late term and post term

A
  • early: 37-38 weeks and 6 days
  • full: 39-40 weeks
  • late: 41 weeks - 41 weeks and 6 days
  • post: 42 weeks and after
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42
Q

dental procedures could harm the developing fetus through the effects of:

A

-ionizing radiation
- drugs: continues post partum from transmission of drugs via breast milk
- stress

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43
Q

what are the common pregnancy discomforts

A
  • nausea and vomiting
  • indigestion
  • headaches
  • polyuria
  • lumbar pain
  • perspiration
  • breast tenderness
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44
Q

what are nausea and vomiting caused by in pregnancy

A
  • hormonal imbalances
  • stress (physical and emotional)
  • hyperacidity
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45
Q

what is indigestion in pregnancy

A

difficulties digesting foods rich in fats, sugars, acids can lead to nausea and vomiting

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46
Q

what should be the considerations for pregnant women and what trimesters can receive tx

A
  • maintain optimal oral health
  • avoid elective dental care during the first trimester
  • second trimester is the best time to perform dental tx
  • after the middle of the third trimester, postpone elective care
  • dental treatment can be safely performed in all trimesters
  • avoid drugs known to be harmful to the fetus
  • lack of proper oral health care during pregnancy could harm the developing fetus and affect the time of delivery
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47
Q

what are the considerations with radiation for women of childbearing age

A

inquire if the patient could possibly be pregnant

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48
Q

what is the gonadal/fetal dose incurred with 2 PA images when a lead apron is used

A

700 times less than that for 1 day exposure to natural background radiations in the US

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49
Q

when should radiographs be taken in pregnancy

A

radiographs are contraindicated in all but emergency situations. when taken lead shielding is mandatory

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50
Q

what are the radiographs recommendations for new and recall pregnant dental patients

A
  • radiographs should be postponed until post partum
  • long term benefit to the health of mother from new patient or recall exam radiographs
  • but no benefit to the health of the developing child
  • unborn child faces greater helath risks from the radiation exposure than the mother without any benefit to their health
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51
Q

what does the national council on radiation protection and measurements recommend for pregnant radiation workers

A

radiation exposure thresholds for pregnant radiation workers is lowered to the same thresholds as the general population

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52
Q

what is the SoD dental radiograph recommendation guidelines for pregnant patients

A

same as NCRP recommendations

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53
Q

what is the protocol with radiographs in emergency pregnant dental patients

A
  • necessary radiogrphs are part of the standard of care to treat and diagnose a condition that threatens the health of the mother an dunborn child
  • lack of radiographs compromises the emergency care diagnosis and treatment, this will directly impact the health of the unborn child
  • primary beam is not directed toward the child bearing area
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54
Q

what is the protocol for emergency dental treatment during pregnancy

A
  • may be provided as needed any time during pregnancy
  • pain control and elimination of infections should be preformed
  • emergency dental tx may require a consult with the obstetrician if there is a concern about medications or effect of emergency tx on fetus
  • untreated dental infections may pose a risk to the developing fetus
  • dental radiographs as needed to establish dx
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55
Q

what might untreated dental infections cause in pregnant patients

A
  • fever and sepsis may precipitate a spontaneous abortion
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56
Q

when should you avoid supine position in pregnant patients and why

A
  • in late third trimester
  • supine hypotension syndrome- due to compression of the IVC that results in impaired venous return to the heart
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57
Q

what does supine hypotension syndrome manifest as

A
  • fall in BP
  • bradycardia
  • sweating
  • nausea
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58
Q

what can patient do to decrerase the effects of supine hypotension syndrome

A

patient can rotate to their LEFT side to allow venous return to recover

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59
Q

what drugs should be avoided in pregnant patients

A
  • all if possible
  • most dental drugs can be safely used in pregnant patients but do not exceed max dose of LA- lido with or without epi is safe
  • avoid aspirin and other NSAIDs
  • opiods should be avoided
60
Q

why should aspirin and NSAIDs be avoided

A
  • closure of the ductus arteriosus
  • risk of post partum hemorrhage and delayed labor
61
Q

what is the analgesic of choice in pregnant patients

A

acetominophen

62
Q

what is the opioid of choice in pregnant patients when discussed with the physician

A

codeine with acetominophen (APAP)

63
Q

what antibiotics are okay to prescribe in pregnant patients

A
  • amoxicillin
  • clindamycin
  • azithromycin
  • metronidazole
  • erythromycin
64
Q

what antibiotics are contraindicated in pregnant pateints and why

A
  • tetracyline and doxycylcine
  • they are teratogenic
65
Q

what are the sedation recommendations for pregnant patients

A
  • no pharmacologic sedation is prefered
  • if necessary, NO may be used for less than 30 minutes and with at least 50% O2
66
Q

what are the considerations when using NO on a pregnant patient

A
  • pt should not have multiple appointments or extended appointment with NO sediation because cumulative effects are a point of concern
  • avoid during first trimester
  • appropriate oxygenation after nitrous is necessary to avoid diffusion hypoxia
  • benzodiazepines should be avoided because of respiratory depression
67
Q

what are the protocols with NO for pregnant workers and why

A

women of child bearing age should not be chronically exposed to nitrous in occupational capacity for more than 3hours per week without scavenging equipment
- risk for decreased fertility and greater rates of spontaneous abortion

68
Q

what is the occupational dose limit for pregnant workers and what are they given to measure this

A
  • personal dosimeter monitoring devices
  • less than or equal to 1mSv/year
69
Q

what is the maximum permissible dose definition

A

the amount of ionizing radiation which in the light of present knowledge will not produce any serious, harmful or deleterious effects on the individual receiving it

70
Q

average dental occupational exposure for pregnant dental workers is:

A

0.2 mSv/year

71
Q

what perentage of pregnant dental workers have readings below the threshold of detection

72
Q

what are the considerations for lactating mothers

A
  • most drugs are of little pharmacologic significance to lactation
  • do not prescribe drugs known to be harmful
  • medications should be taken just after breat feeding
73
Q

what might be the periodontal effects seen in pregnant or lactating mothers

A
  • periodontium- can range from mild inflammation to severe overgrowth, the hormonal increase can exaggerate the gum tissues response to bacterial plaque
  • tooth moility may be present
  • prevention, good oral health and perio maintenance is important for your pregnant patients or those considering becoming pregnant
74
Q

what are the oral complications in pregnancy

A
  • exacerbation of underling periodontal disease
  • increased risk of pyogenic granuloma
  • gingivitis is the most common oral condition in pregnancy -60-75% of pregnant women
75
Q

pregnancy gingivitis and exacerbated periodontitis affected by:

A
  • lack of attention to OH
  • increased systemic fluid levels from increased progesterone and estrogen exacerbate any existing gingival/periodontal condition
76
Q

what are the other names for pyogneic granuloma

A
  • epulise gravidarum
  • pregnancy tumor
77
Q

describe pyogenic granulomas

A
  • not an actual granulmona as there is proliferation of vascular tissues as well as proliferation of fibrous tissue
  • forms submucosally and takes the shape of nodular growth
  • in pregnancy, it is an exacerbated response to plaque and bacteria precipitated by the changes in progesterone and estrogen hormonal levels
78
Q

what is the tx for pyogenic granuloma

A
  • nothing it will resolve after
  • keep it clean because it can get affected
79
Q

what are the considerations for patients with gestational diabetes

A
  • high blood sugar affecting pregnant women who have insufficient insulin production relative to metabolic needs
  • in some instances, it may also be insulin resistance
  • gestational diabetics are at higher risk of developing type 2 diabetes later in life
  • generally asymptomatic
80
Q

what are the risks to the fetus with gestational diabetes

A
  • fetus can have excess weight gain
  • affects lung development
  • delivery may require cesarean section
81
Q

what are the general treatment considerations for gestational diabetes

A
  • daily blood sugar monitoring
  • healthy diet
  • exercise
  • monitoring the baby
82
Q

if conservative measure are not responsive and blood sugar remains high in gestational diabetes then:

A
  • medical intervention like the intervention for type 2 diabetes is indicated
  • Intramuscular insulin
  • or metformin - preferred method
83
Q

what hormone is secreted from the glomerulosa zone and the action

A
  • aldosterone
  • kidneys- distal tubules
  • intravascular volume and RAA system
  • regulates Na and water balance - affects BP
84
Q

what does the zona fasciculata secrete and what are the actions

A
  • cortisol
  • increases contractility and vascular reactivity to vasoconstriction resulting in increased BP
  • antagonizes insulin
  • activates lipolysis - increased FFA
  • stimulates gluconeogenesis- results in increased sugar, insulin intolerance and cholesterol
  • muscle catabolism- increases glucose
  • decreases calcium absorption and activates osteoclasts- results in osteoporosis
  • inhibits PLA2 and mobilization , migration, function of leukocytes - results in decreased immune response
  • increases appetite, suppresses sleep, regulates emotion and memory
  • increases intraocular pressure
85
Q

what does zona reticularis secrete and what are the actions

A
  • androgens
  • gonads
  • sexual maturation, growth and development
86
Q

what does norepinephine and epinephrine do

A
  • fight or flight stress response
  • increases BP, peripheral resistance, CO
87
Q

what does hyperadrenalism cause

A
  • increased aldosterone, cortisol, androgen, estrogen isolate or in combination
88
Q

what is seen in hyperaldosteronism

A
  • hypertension
  • hypokalmemia
  • edema
89
Q

what is glucocorticoid excess

A
  • most common
  • high levels of cortisol
  • cushing disease - pituitary or adrenal tumor
  • cushing syndrome- exogenous corticosteroids
90
Q

what are the diseases associated with the adrenal gland

A
  • hyperadrenalism
  • hyperaldosteronism
  • glucocorticoid excess
91
Q

what are the complications of glucocorticoid excess

A
  • diabetes
  • hypertension
  • weight gain
  • moon facies
  • buffalo hump
  • hirsutism
  • acne
  • osteoporosis
  • delayed wound healing
  • susceptibility to infection
  • irregular menses insomnia
  • psychiatric disorders
  • peptic ulcers
  • glaucoma and cataracts
92
Q

what does the acronym CUSHINGOID stand for

A

-Cataracts
-Ulcers
-Striae and skin thinning
-Hypertension and hirsutism
- Immunosuppression and infections
- Necrosis of femoral heads
- Glucose elevation
- Osteoporosis and obesity
-Impaired wound healing
-Depression and mood changes

93
Q

what are the cutaneous findings in cushing syndrome

A
  • increased central adiposity with thinning of the extremities
  • skin thinning and easy bruising
  • violaceous striae
  • acanthosis nigricans
  • increased dermatophyte and candidal skin and nail infections
  • hyperpigmentation
94
Q

what are the diseases seen with cushing syndrome

A
  • diabetes
  • HTN
  • osteoporosis
  • irregular menses
95
Q

what is the dx of cushing syndrome

A
  • measurement of 24 hour urinary free cortisol and late night salivary cortisol
  • failure to suppress cortisol production with a low dose dexamethoasone suppression test
96
Q

what is the management of cushing disease

A
  • appropriate endocrine and surgical consultation
  • surgical removal of pituitary or adrenal tumor
  • adrenal enzyme inhibitors
  • radiation therapy
97
Q

what are the immediate acting glucocorticoids prescribed for cushings

A
  • prednisone
  • triamcinodone
  • methylprednisome
98
Q

what are the long acting glucocorticoids prescribed for cushing disease

A
  • dexamethasone
  • betamethasone
99
Q

what is another name for primary adrenal insufficiency

A

addison disease

100
Q

describe addison disease

A
  • destruction of adrenal cortex
  • decreased cortisol and increased ACTH
  • cannot tolerate stress: adrenal crisis
101
Q

what is the etiology of addison disease

A
  • most commonly autoimmune
  • chronic infectious disease and sepsis: HIV, CMV, fungal infection
  • drugs
102
Q

what is the treatment for addisons

A
  • lifelong replacement therapy of glucocorticoids and mineralocorticoids
  • requires cortisol replacement
  • surgery and stress may require supplemental corticosteroids
  • pain control is important
103
Q

what are the cutaneous findings in addison disease

A
  • hyperpigmentation of the skin and mucous membranes
  • longitudinal pigmented bands in the nails
  • vitilgo
  • decreased axillary and pubic hair in women
  • calcification of auricular cartilage in men
104
Q

what are the related features in addison disease

A
  • abdominal pain
  • electrolyte abnormalities- hyponatremia and hyperkalemai
  • postural hypotension
  • anorexia and weight loss
  • fatigue
  • shock, coma and death if untreated
105
Q

how is addison dx

A

failure to respond adequately to corticotropin test

106
Q

describe secondary adrenal insufficiency

A
  • impaired/destructive pituitary disease
  • decreased cortisol and decreased ACTH, aldosterone unchanged
  • lower dose replacement therapy
107
Q

describe teriary adrenal insuffiency

A
  • impaired function of hypothalamus
  • most commonly a result of chronic exogenous steroid use
  • lower dose replacement therapy
108
Q

does hyperpigmentation and adrenal crisis usually occur with tertiary adrenal insufficiency

A

not usually or it is less likely

109
Q

what should be considered with hyperadrenalism

A
  • BP and glucose levels
  • avoid NSAIDs and aspirin -> peptic ulcers and GI bleed
  • if osteoporosis and osteopenia->more prone to periodontal bone loss. may have history of bisphosphonate use
110
Q

impaired wound healing in adrenal diseases may be a consequence of:

A

hyperadrenalism and adrenal insufficiency

111
Q

the necessity for supplemental corticosteroids in adrenal insufficiency depends on

A
  • type
  • severity/stability/medical status
  • dental proceudre being perfromed (long: greater than 1hr or invasive)/ type of stress/dental infection
112
Q

what are the signs of adrenal crisis

A
  • hypotention- monitor BP - vasopressors, patient position, fluid replacement
  • abdominal pain
  • myalgia
  • fever
  • supplement with 100mg of hydrocortisone and send to ED
113
Q

what are the pain control protocols with adrenal insufficiency

A
  • adequate anesthesia, long acting agent at end of procedure
  • good post op pain control
114
Q

thyroid function involved in:

A

developmental and metabolic processes

115
Q

thyroid function depends o:

116
Q

what hormones does the thyroid produce

A
  • T3 and T4
  • calcitonin
117
Q

what are T3 and T4 controlled by

A

TSH in the pituitary

118
Q

what does calcitonin do and what is it influenced by

A
  • regulates circulating calcium and phosphorus levels
  • influenced by actions of PTH and vitamin D
119
Q

what is the effect and mechanism of thyroid hormones on the heart

A
  • chronotropic and inotropic
  • increased number of beta adrenergic receptors
  • enhanced responses to circulating catecholamines
  • increased proportion of alpha myosin heavy chain with higher ATPase activity
120
Q

what is the effect and mechanism of thyroid hormones on adipose tissue

A
  • catabolic
  • stimulates lipolysis
121
Q

what is the effect and mechanism of thyroid hormones on muscle

A
  • catabolic
  • increased protein breakdown
122
Q

what is the effect and mechanism of thyroid hormones on bone

A
  • developmental
  • promote normal growth and skeletal development
123
Q

what is the effect and mechanism of thyroid hormones on nervous system

A
  • developmental
  • promote normal brain development
124
Q

what is the effect and mechanism of thyroid hormones on the gut

A
  • metabolic
  • increased rate of carbohydrate absorption
125
Q

what is the effect and mechanism of thyroid hormones on lipoprotein

A
  • metabolic
  • formation of LDL receptors
126
Q

what is other effects and mechanism of thyroid hormones

A
  • calorigenic
  • stimulated oxygen consumption by metabolically active tissues except testes, uterus, lymph nodes, spleen and anterior pituitary
  • increased metabolic rate
127
Q

what are the thyroid disroders

A
  • thyroid enlargement- goiter
  • thyroid nodules
128
Q

describe thyroid enlargement disorders

A
  • may be functional or non functional
  • most are nonfunctional (euthryoid)
  • hyperthyroidism goiter- graves disease
  • hypothyroidism goiter - hashimoto thryoiditis
129
Q

what are the thyroid nodule disorders

A
  • hyperplasia
  • adenoma
  • carcinoma
130
Q

what are the neoplasms of the thyroid

A
  • adenoma
  • carcinoma- papillary and follicular
131
Q

what are the symptoms of hyperthyoidism

A
  • unintentional weight loss
  • heat intolerance/ sweating
  • palpitations
  • agitation/emotional lability
  • multiple daily loose stools
  • pruritis
  • weakness
  • oligomenorrhea in women
132
Q

what are the clinical findings and complications in hyperthyroidism

A
  • goiter
  • tachycardia
  • atrial fibrillation
  • high output cardiac failure
  • fine tremor
  • hot sweaty extremities
  • ophthalmopathy
  • agitation/confusion
  • muscle weakness/wasting
  • thyroid storm with fever, confusion, dehydration and eventual death if untreated
133
Q

what is the diagnosis of hyperthyroidism

A
  • increased free T4
  • decreased TSH
  • best initial test is serum thyroid stimulating hormone - low
  • other tests include serum free thyroxine (T4), total triiodothyronine (T3) and thyrotropin receptor antibodies
  • radioactive iodide uptake and imaging
134
Q

what is the management of hyperthyroidism

A
  • appropriate surgical and endocrine consultation
  • propanolol for symptomatic treatment of tremor, tachycardia and sweating
  • proplythiouracil to inhibit hormone metabolism and concentration of T4 to T3
  • methimazole to inhibit thyroid hormone synthesis
  • radioiodine ablation of the thyroid gland
135
Q

thyroid storm/crisis may be precipitated by:

A

oral infection or surgical procedure in a patient who is poorly controlled

136
Q

what are the symptoms of hypothyroidism

A
  • unexplained weight gain
  • fatigue
  • cold intolerance
  • constipation
  • dry skin
  • muscle weakness
  • carpal tunnel syndrome
  • hoarseness
  • decreased body temperature
  • facial swelling
  • menorrhagia in women
137
Q

what are the clinical findings and complications in hypothyroidism

A
  • goiter
  • cold, doughy skin
  • bradycardia
  • facial and finger swelling
  • slowed relaxation of deep tendon reflexes
  • hair loss/lateral eyebrow loss
  • pericardial effusion
  • MI or CHF with aggressive thyroid hormone replacement
  • coma and death without treatment
138
Q

what are the related features in hypothyroidism

A
  • macroglossia
  • broadened nose, thickened lips, puffy eyelids
  • impaired wound healing
  • cretinism in patients with congenital hypothyroidism
  • myxedema coma
139
Q

what is the dx of hypothyroidism

A
  • decreased free T4
  • decreased or increased TSH
  • best initial test is serum thyroid stimulating hormone- elevated
  • other useful tests include serum free thyroxine (T4), total triiodothyronine (T3), antithyroperoxidase (anti-TPO) antibodies, and lipid panel
140
Q

what is the management of hypothyroidism

A
  • appropriate endocrine consultation
  • oral thyroxine replacement - usually in the range of 75-150 micrograms per day
  • careful follow up for heart, lung and adrenal disease
141
Q

what is the oral manifestations of hyperthyroidism

A
  • increased periodontal bone loss
  • increased susceptibility to caries
142
Q

what are the oral manifestations of hypothyroidism

A
  • delayed tooth eruption and altered bone formation
  • macroglossia
  • dysgeusia and burning mouth
  • salivary gland enlargement
  • oral lichen planus
143
Q

patients with both hyper and hypothyroidism may be more susceptible to______ so you need to treat ______

A

infections; aggressively

144
Q

what is the risk for uncontrolled thyroid disorders

A
  • risk of agranulocytosis from medications used to treat hyperthyroidism
  • thyrotoxic crisis/storm in hyperthyroidism
  • myxedema coma- hypothyroidism
145
Q

what should you do if there is a thyrotoxic crisis/storm

A
  • CPR and vital signs
  • ice packs or wet packs
  • administer hydrocortisone 100-300mg
  • IV glucose
  • administer propylthiouracil
  • send to ED
146
Q

what should you do if there is myxedema coma

A
  • CPR and vital signs
  • conserve body heat- blanket
  • administer hydrocortisone 100-300 mg
  • IV saline and glucose
  • administer thyroxine
  • send to ED
147
Q

what are the warning signs of agranulocytosis

A
  • fever
    -sore throat
  • oral ulcers
148
Q

what are the drug interactions/side effects in hyperthyroidism

A
  • caution with aspirin and NSAIDS can increase T4
  • ciprofloxacin contraindicated- decreases absorption of thyroid hormone
  • avoid local anesthetics containing epinephrine and ginvial retraction cord with epi in poorly controlled patients
149
Q

what are the drug interactions/side effects in hypothyroid patients

A
  • avoid CNS depressants such as narcotics, barbituates and sedatives if the patient is poorly controlled
  • cytochrome p450 inducers such as phenytoin, carbamazepine, and rifampin should be avoided because it increases metabolism of levothyroxine

Dental Management of the Medically Complex Patient (13 decks)

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