Hashimoto's thyroiditis

Question 1

Describe Hashimoto’s thyroiditis (hypothyroidism) and who it affects most

Answer 1

Description:
• Immune system cells attack the thyroid gland, causing inflammation. Thus, the thyroid doesn’t make enough thyroid hormone for the body’s needs (hypothyroidism)

Who affects most
• Women, especially those 30- 50 years old

Question 2

List the general signs and symptoms of Hashimoto’s thyroiditis (10)

Answer 2

• Fatigue, muscle weakness
• Increased cold sensitivity, pale, dry skin
• Retained fluid -> unexplained weight gain -> puffy face
• Constipation
• Hoarse voice
• Muscle aches, tenderness and stiffness
• Pain and stiffness in joints
• Swelling in knees or the small joints of hands and feet
• Excessive or prolonged menstrual bleeding (menorrhagia)
• Depression

Question 3

List the oral signs and symptoms of Hashimoto’s thyroiditis (7)

Answer 3

• Salivary gland enlargement
• Compromised periodontal health (delayed bone resorption)
• Macroglossia
• Glossitis
• Dysgeusia
• Delayed dental eruption
• Enamel hypoplasia

Question 4

List and explain the dental considerations for Hashimoto’s thyroiditis (4)

Answer 4

• Excessive bleeding: Subcutaneous mucopolysaccharides decreases the ability of small blood vessels to constrict when cut = excess bleeding. Local pressure for an extended time should stop the bleeding
• Delayed wound healing: Delayed wound healing due to decreased metabolic activity in fibroblasts.
• CVD: Patients who have hypothyroidism are susceptible to cardiovascular disease from arteriosclerosis and elevated LDL
• Patients who have atrial fibrillation can be on anticoagulation therapy and might require antibiotic prophylaxis before invasive procedures, depending on the severity of the arrhythmia. If valvular pathology is present, the need for antibiotic prophylaxis must be assessed

Question 5

Describe the overall dental management of Hashimoto’s thyroiditis (3)

Answer 5

• Before treating, consult with their GP who can provide information on their cardiovascular statuses
• Patients who have atrial fibrillation can be on anticoagulation therapy and might require antibiotic prophylaxis before invasive procedures
• If valvular pathology is present, the need for antibiotic prophylaxis must be assessed

Question 6

List the risk factors/ causes for Hashimoto’s thyroiditis (3)

Answer 6

• Genetic predisposition (researchers are working to identify the gene)
• Possible environmental factors are also being studied e.g. iodine, pesticides, certain medications and viral infections
• People with other autoimmune diseases are more likely to develop Hashimoto’s disease and vice versa e.g. Rheumatoid Arthritis, Addison’s disease, Diabetes Mellitus Type 1, Celiac disease etc.