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DENT :D > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Dental Complications of undiagnosed/ poorly controlled Hyperthyroidism

  • drug reactions
  • adverse complications
A
  • predisposed to adverse interaction with epinephrine
    • life-threatening cardiac arrhythmias
    • congestive heart failure (CHF)

Thyrotoxic crisis or thyroid storm precipitated by
a. infection or b. surgical procedures

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2
Q

Dental Complications of patients with Hypothyroidism that is undiagnosed or poorly controlled
- drug reactions

A

exaggerated response to central nervous system (CNS) depressants
(sedatives and narcotic analgesics)

• myxedematous coma precipitated by CNS depressants, infection, or surgical procedure

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3
Q

Function of Thyroid Gland

A

Function
• development and normal growth and development of skeletal and nervous systems and
maturation of reproductive system.
• metabolic ( lipid, protein, carbohydrate) and cell respiration as well as turnover of essentially all substances, vitamins, and hormones
• Iodine is an essential requirement for thyroid hormone synthesis.

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4
Q

Hypothyroidism

- clinical presentation

A 
physical features:
dry hair, coarse sparse
Lateral eyebrows thin
Periorbital edema
Puffy dull face with dry skin

MYXOEDEMA refers to the accumulation of mucopolysaccharide (decrease in degradation) in the subcutaneous tissues producing a non-pitting edema - when you push it down, it won’t return

CRETINISM:
Childhood hypothyroidism
• thick lips
• large protruding tongue (macroglossia),
• malocclusion and delayed eruption of teeth
• Failure to growth
• intellectual disability. .

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5
Q

Hypothyroidism; Clinical manifestations

A

Musculoskeletal—arthritis, muscle cramps
• Cardiovascular—shortness of breath, hypotension,
slow pulse
• GI—constipation, anorexia, nausea or vomiting
• CNS—mental and physicals lowness, sleepiness, headache
• General—dry, thick skin and dry hair
• fatigue; edema (puffy hand, face, eyes)
• coldintolerance;
• hoarseness;
• weight gain

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6
Q

Hypothyroidism- Oral Manifestations

A 
- Myxedema of the skin and lip
• enlarged tongue (macroglossia)
• compromised periodontal health
• delayed tooth eruption
• delayed wound healing
• hoarse voice
• Salivary gland enlargement
• changes in taste
• burning mouth symptoms
• xerostomia and impaired salivary output
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7
Q

What is hyperthyroidism

A

Excess production of thyroid hormone
• Markedly increased metabolism
• Graves disease (60% to 90%);
• autoantibodies against receptors for thyroid- stimulating hormone (TSH) on the surface of the thyroid cells.
• When the autoantibodies bind to these receptors, they seem to stimulate the thyroid cells to release inappropriate thyroid hormone.

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8
Q

Hyperthyroidism

SYMPTOMS

A

i.e. graves disease

Skeletal—osteoporosis (increase bone loss)
• Cardiovascular—palpitations, tachycardia, arrhythmias, hypertension, cardiomegaly, congestive heart failure, angina, MI
• GI- weight loss, increased appetite, pernicious anemia
• CNS—anxiety, restlessness, sleep disturbances, emotional lability, impaired concentration, weakness, tremors (hands, fingers, tongue)
• Skin—erythema, thin fine hair, areas of alopecia, soft nails, pigmentations
• Eyes—retraction of upper
eyelid, exophthalmos, corneal ulceration, ocular muscle weakness
• Other—increased risk for diabetes, decreased serum cholesterol level, increased risk for thrombocytopenia, increase sweating

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9
Q

Things that are COMMON in both hypo and hyperthyroidism

A

hair loss
goiter
Irregular menstrual periods
depression, mood swings

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10
Q

2 Key characteristics of Hyperthyroidism

A

Widened pulse pressure
(increased systolic and decreased diastolic pressures)

Prominant EYES are characteristic of the exophthalmos.

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11
Q

Hyperthyroidism: oral manifestations

A

premature loss of deciduous teeth with early eruption of permanent teeth
• lingual “thyroid” (consisting of thyroid tissue posterior to the foramen cecum ( big mass like growth at the back of the tongue- can’t remove it because it may be there only thyroid gland) )

Osteoporosis involving the alveolar bone 
• Rapid development of caries
• Periodontal diseases
• Change in taste and smell
• Thyroid Disease and Lichen Planus
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12
Q

Giveaway signs of Hyperthyroidism through oral exam

A

Hyperthyroidism
• Exacerbate the patient’s response to dental pain and anxiety
IDENTIFICATION
• Pay attention to Signs&Symptoms on Routine examination of the head and neck
• changes in oculomotor function
• protrusion of the eyes
• excess sweating
• Thyroid and tongue exam; enlargement of the thyroid or the tongue
• lingual thyroid tissue
• difficulty in swallowing.

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13
Q

Dental Management of Thyroidism

A

Risk Assessment
• Complete medical history , signs and symptoms
• Consultation if necessary

• Well-controlled hyper/hypothyroidism does not present any major risks to the patient undergoing dental care.

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14
Q

ANALGESIC consideration for uncontrolled Hyperthryoidism

A

Aspirin and other NSAIDs can increase the amount of circulating T4, making control of thyroid disease more difficult. Use appropriately.

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15
Q

Antibiotic Consideration for uncontrolled hyperthyroid patients

A

Avoid Ciprofloxacin with levothyroxine (decrease absorption of the thyroid hormone.

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16
Q

Anesthesia Considerations for patients with Hyperthroidism uncontrolled

A

Avoid using epinephrine in local anesthetics

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17
Q

Anesthesia vs Analgesics

A

Analgesia is the relief of pain without the loss of consciousness or sensation (e.g., Aspirin, Carprofen, etc.).

Anesthesia, on the other hand, is the loss of physical sensation with or without loss of consciousness using anesthetics (e.g., Ketamine, Propofol, Isoflurane, etc.).

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18
Q

Anxiety considerations in uncontrolled hyperthyroidism

A

Patients with untreated or poorly controlled disease may appear very anxious

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19
Q

Bleeding consideration in uncontrolled /poorly controlled hyperthyroidism

A

Excessive bleeding due to thrombocytopenia*

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20
Q

Breathing and chair position consideration for poorly controlled hyperthryroidism

A

No issues

21
Q

Blood pressure dental consideration for poorly controlled hyperthyroidism

A

Monitor the blood pressure because of chance of elevation

22
Q

Cardiovascular dental consideration for poorly controlled hyperthyroidism

A

Patients with untreated or poorly controlled disease may be subject to arrhythmias

23
Q

Drug considerations for poorly controlled hyperthyroidism

A

be cautious for epi and antithyroid drugs:

Avoid epinephrine or gingival retraction cords to control bleeding in untreated or poorly treated thyrotoxic patients.

Common side effects of the antithyroid drugs (methimazole and propylthiouracil) are rash, pruritus, fever, and arthralgias. AGRANULOCYTOSIS and hepatitis are rare but serious complications of the antithyroid drugs.

24
Q

SEVERE Side Effects of Antithyroid Drugs

A

Severe

Agranulocytosis
Hepatitis (can result in hepatic failure) Cholestatic jaundice Thrombocytopenia

Hypoprothrombinemia
Aplastic anemia
Lupus-like syndrome with vasculitis Hypoglycemia (insulin antibodies)

25
Q

LESS SEVERE side effects of antithyroid drugs

A 
Most Frequent (1%–5%)
Rash
Urticaria
Arthralgia
Decreased leukocyte level (drop in white blood cell counts by 2–3
× 103) Fever

Less Frequent
Arthritis
Diarrhea
Decreased sense of taste

26
Q

What are patient presentations that signal signs of antithyroid drug toxicity

A

antithyroid drugs: propylthiouracil
carbimazole

so this would be for patients with hyperthyroidism that are taking these drugs:

Patients taking anti thyroid drugs who develop fever, sore throat, or oral ulcerations should seek urgent medical care (possible agranulocytosis).

Patients who develop jaundice and abdominal pain (possible hepatitis) should seek urgent medical care.

27
Q

Thyrotoxic Crisis/storm

A

Predisposing factors: Surgeries or oral infections

Management
• Seek medical aid
• vital signs must be monitored and
• CPR initiated if necessary;
• apply wet packs or ice packs; (for the fever)
• inject 100 to 300 mg of hydrocortisone, IV glucose solution;
• administer propylthiouracil; and transport patient to emerg medical facilities

28
Q

Which is more common, hypo or hyper thyroidism?

A

hypothyroidism

29
Q

Analgesic consideration for Hypothyroid Patients

( uncontrolled or poorly controlled )

A

Avoid Narcotics

30
Q

Antibiotic considerations for Hypothyroid Patients

( uncontrolled or poorly controlled )

A

In patients with poorly controlled as well as well-controlled disease, treat acute infection aggressively using appropriate antibiotics and incision and drainage when indicated.

31
Q

Anesthesia considerations for Hypothyroid Patients

( uncontrolled or poorly controlled )

A

No issue

32
Q

Anxiety considerations for Hypothyroid Patients

( uncontrolled or poorly controlled )

A

Avoid CNS depressants such as narcotics, barbiturates, and sedatives in patients with poorly controlled disease.

33
Q

bleeding, breathing, blood pressure, chair position, cardiovascular considerations for Hypothyroid Patients
( uncontrolled or poorly controlled )

A

no issues

34
Q

Drug considerations for Hypothyroid Patients

( uncontrolled or poorly controlled )

A

Phenytoin, phenobarbital, carbamazepine, and rifampin should be used with care because they increase the metabolism of thyroid replacement drugs.
Ferrous sulfate, calcium carbonate, and aluminum hydroxide can interfere with thyroxine absorption (thyroxine doses should be separated from ingestion of these substances by 4 or more hours).

35
Q

Myxedema Coma

  • what is it
  • symptoms
A

Medical emergency with high mortality rate
• severe hypothyroidism leading to decreased mental status, hypothermia, progressive lethargy, stupor, and coma.
Bradycardia
Hyponatremia
Hypoglyceia
Hypotension
Precipitating illness

36
Q

Triggers of Myxedema Coma

A

Triggers
• Acute oral infection • CNS depressants
• surgical procedure

37
Q

Dental Management of Myxedema coma

A

This is an Emergency*

Seek medical attention (911)
• vital signs must be monitored
• CPR initiated if necessary.
• Cover patient to conserve body heat;
• inject 100 to 300 mg of hydrocortisone, thyroxine (1.8 μg/kg daily with a 500-μg loading dose), IV saline, and glucose;
• transport to medical emergency facility.

38
Q

Q1. Hypothyroidism affects the dental developmental pattern by
A. interfering with jaw growth.
B. delaying the eruption timetable.
C. causing sclerotic bone to form over the occlusal surface of erupting teeth.
D. accelerating the eruption timetable.

A

B. Delayed erruption

39
Q 
Question 2
Hypothyroidism in adults is associated with
A. exophthalmos.
B. weight loss.
C. generalized edema.
D. tachycardia.
E. mental defects.
A

C. mental defects?

40
Q 
Question 3
• Reduced thyroid hormone level in a child is associated with 
• A. lack of tooth eruption.
• B. early tooth eruption.
• C. delayed tooth eruption.
• D. supernumerary teeth.
A

C. delayed

41
Q

Question 4
• Which of the following diseases predisposes a patient to exaggerated cardiovascular effects of epinephrine?

a. Hyperparathyroidism.
b. Hyperthyroidism.
c. Hypogonadism.
d. Acromegaly.

A

B. hyperthyroidism

42
Q 
Question 5
• Epinephrine should NOT be used as a vasoconstrictor for patients with uncontrolled
A. hyperthyroidism.
B. hyperparathyroidism.
C. myxedema. D. asthma.
A

A. hyperthyroidism

43
Q 
Question 6
• A patient with suspected hyperthyroidism may display all of the following early symptoms EXCEPT
• A. fine and brittle hair.
• B. excessive sweating.
• C. tachycardia.
• D. weight loss.
• E. tendency to bruise easily.
A

A.

44
Q 
Question 7
• A patient with hyperthyroidism may exhibit 
A. weight gain.
B. delayed eruption of teeth.
C. exophthalmos.
D. gingival inflammation.
A

C

45
Q

Question 8
• Which of the following must be instituted prior to exodontia for a patient with symptoms of mild hypothyroidism?
1. An INR test within 24hours prior to appointment.
2. Constant blood pressure monitoring.
3. Short early morning appointments.
4. Supine or head down chair positioning.
5. No special considerations are required

A
  1. BP monitoring
46
Q 
Question 9
• Myxedema is associated with
1. insufficient parathyroid hormone. 
2. excessive parathyroid hormone. 
3. insufficient thyroid hormone
4. excessive thyroid hormone
A
  1. insufficient thyroid hormone
47
Q 
10. Enlargement of the thyroid gland can be caused by 
• A. insufficient fluoride.
• B. excess iodine.
• C. insufficient iodine.
• D. excess calcium. 
• E. excess sodium.
A

C?

48
Q 
Question 11
• Which of the following is NOT a clinical finding of hypothyroidism? 
1. Anxiety.
2. Mildtremor.
3. Puffyeyelids.
4. Exophthalmos.
A
  1. exophthalmos
49
Q 
Question 12
• Exophthalmia may be a sign of 1. hypoadrenalism
2. hyperadrenalism
3. hypothyroidism
4. hyperthyroidism
5. hypoparathyroidism
A
  1. hyperthyroidism

DENT :D (7 decks)

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