Grave's disease

Question 1

Describe Grave’s disease by:
• Defining hyperthyroidism
• Who is mostly affected by hyperthyroidism
• What Grave’s disease is

Answer 1

Definition:
• Hyperthyroidism means the thyroid gland is overactive. Grave’s disease is the most common form of hyperthyroidism

Who is most affected:
• Has a genetic predisposition and mostly affects women aged 30- 40

What is Grave’s disease
• Autoimmune disease: antibodies are made against the thyroid cell surface receptors that accept the thyroid stimulating hormone (TSH)
• The antibodies bind act as an antagonist with high affinity and bind to the thyroid cell surface receptors, causing excessive and uncontrolled production of thyroid hormones

Question 2

List the general signs and symptoms of Grave’s disease (15)

Answer 2

• Goiter (enlarged thyroid)
• Trouble sleeping
• Irritability or nervousness
• Heat sensitivity, increased sweating
• Hand tremors
• Rapid heartbeat
• Bulging eyes
• Thinning of skin or fine, brittle hair
• Frequent bowel movements
• Weight loss without dieting
• Fatigue or muscle weakness
• Thickened red skin on shin or feet
• Tissues behind eye become inflamed and swollen
• Lighter menstrual flow and less frequent periods
• Problems getting pregnant

Question 3

List the oral signs and symptoms of Grave’s disease (8)

Answer 3

• Increased susceptibility to caries
• Increased susceptibly to periodontal disease
• Enlargement of extra glandular thyroid tissue
• Burning mouth syndrome
• Accelerated dental eruption
• Maxillary and mandibular osteoporosis
• Enamel hypoplasia
• Development of connective tissue diseases like Sjogrens Syndrome or lupus

Question 4

Explain the dental/health considerations of Grave’s disease (4)

Answer 4

• May have elevated blood pressure and heart rate
• Anti-thyroid drugs has anti-vitamin K activity and can cause excessive bleeding = haemorrhage
• Susceptibility to infection
• Increased anxiety, stress or surgery can trigger a thyrotoxic crisis

Question 5

Describe the overall dental management of Grave’s disease (4)

Answer 5

• Stress reduction
• Awareness of drug side effects or interactions
• Vigilance for appearance of signs or symptoms of hormone toxicity
• High arteriolar pressure requires attention due to longer duration of bleeding