Thyroid do- is the ___ most common endocrine disorder
- affects aprox ___ million americans
- onset usually b/t ___ and ___ yrs age, and is at least ___ times more common in ____
- gland secretes 3 hormones?
- ___ is the major circulating form, is important in regulation of body’s ____ ___, affects ___/___/___ metabolism, and potentuates the action of ____ and ___ ___
- insuff or excess thyroid hormone production leads to life-threatening ___ events
2nd
- 12
- 20 - 40, 5x, females
- thyroxinn (t4), triiodothyronine (T3) and calcitonin
- Thyroxine, metabolic rate, lipid/protein/carb; catecholeamines and growth hormones
- cardiac
Hypothyroidism- characterized by ____ production of thyroid hormone resulting in a ____ of ____ processes
- eto include? (5)
- ptn with untreated hypothy are sensitive to actions of ____, ____, and ____
- stressfull situation such as ___, ____, ____ or ___ may precipitate ____ ____
decreased; slowing of metabolic
- surgical removal
- radiation
- drug induced
- pituitary or hypothalmic dx
- chronic autoimmune thyroiditis (hashumoto’s thyroiditis)
- surgical removal
- barbituates, narcotics, tranquilizers
- cold, trauma, infection, surgery; myxedema coma
Myxedema- severe form of ___ ____; ____ edema secondary to the accumulation of ________ in the skin
-characterized by? (7)
adult hypothyroidism; non-pitting, mucopolysaccharide
- dull facial expression
- puffy eyes
- dry rough skin
- slow mental activity
- increased tongue size
- horse speech
- sensitivity to cold
Myxedema coma- rare ____ ____, can arise spontaneously or as a result of __ ___, ____ (___, ____) or _____
- clinical signs? (4)
- management of suspected in dental office consists of placing ptn in a _____ position with __ ___ ___, activate EMS and provide BLS while waiting for medical assistance. If equipted establish __ __ and initiate infusion of ___ ___ or ___ ___
life-threatening emergency; cold exposure, meds (analgesics, sedatives); infection
- hypotention, hypoventilation, hypoxia, and severe hypothermia
- supine, legs slightly elevated; IV access, 5% dextrose or normal saline
Cretinism- ___ or ___ onset
-characterized by? (8)
- neonatal or childhood
1. dwarfism
2. broad flat nose
3. thick lips
4. large protruding tongue
5. malocclusion
6. delayed eruption of teeth
7. horse cry
8. mental retardation
Hyperthyroidism (thyrotoxicosis)- is consequence of ___ __ ___ formation or the excessive _____ of ___ ___ ___
- onset coincides with ___, ____, or ___
- more common in ____ (___:1)
excessive thyroid hormone; administration endogenous thyroid hormone
- puberty, menopause, pregnancy
- females; 7
Hyperthyroidism results in:
1) increased ___ ___ and ___ ___
2) ___ ____
3) decreased ____ function
- metabolic activity, cardiac workload
- cardiac irritability
- liver
Eto of hyperthyroidism include:
- ____ dx (an ____ disorder)
- __-induced hyperthyroidism
- excessive ___ ____
- ___ ___ tissue
- toxic ____
- ___ ____
- grave’s dx (autoimmune)
- iodine
- pituitary TSH
- ectopic thyroid
- toxic adenoma
- multinodular goiter
Signs and symptoms of hyperthyroidism? (10)
- sweating, warm moist skin, heat intolerance
- tachycardia, atrial fibrillations
- fine thin hair
- tremors, nervousness, and agitation
- exopthalmos
Medical management of hyperthyroidism:
-antithyroid medications: ____ ___, _____, _____
;also ____ or ___ ___
-untreated or incompletely treated hyperthyroid ptns are highly sensitive to ____ or other _____
*use of these drugs may precipitate a ___ ____; ___,___,___ and ___ may also be precipitating factors
- potassium iodide, metimazole, propylthiouracil; thyroidectomy or radioactive iodine
- epinephrine, catecholamines
- thyroid crisis, stress, surgery, infection, trauma
Hyperthyroid crisis (thyrotoxicosis, thyroid storm)- is a rare but ____ complication. It is the ___ ______ of the signs and symptoms of hyperthyroidism.
- precipitating factors include ___ ____ (___ and other ___), s/s/t/i
- clinical manifestation includes? (7)
- CNS signs include: initial ___&___ followed by ___ and ____
- even with proper medical management, thyroid storm caries a __ ____ ___
life-threatening; acute exaccerbation -pressor amines (epinepherine, catecholamines) -sweating, tachycardia, atrial filbrilation nausea, vomitting abdominal pain congestive heart failure -tremor & agitation, stupor and coma -high mortality rate
Medical management of hyperthyroid crisis: just two additional items diff from management of hypothyroid ptn:
- ___ patient with __ ___
- administer __ ____ ___mg
- cool, cold packs
- IV hydrocortisone 100mg
Oral complications of hyperthyroidism:
- ____ of the ___ bone and ___
- more rapid development of ___ & ____, ___ and ___
- premature loss of ____ ___, early ___ of ___ ____ may result in ____
- rarely __ ___ tissue located in the area of the ___ ___
- recognize that antithyroid medications may result in ___ ___ and ____ or ___ & ____
- osteoporosis, alveolar bone and jaws
- caries & periodontitis, teeth and jaws
- decidious teeth, eruption of permanent teeth; malocclusion
- ectopic thyroid, foramen cecum
- altered taste soreness of gums and teeth
Dental tx consideration for ptns with thyroid dx:
1) Complete medical hx to determine ___ ___, ___, and ___ __ ___
2) Ptns who are currently euthyroid w/ normal lab values may undergo ____ dental tx; judicious use of __ __, ___, ___ and ___ is recommended
- well-controlled thyroid ptns- ___ __ as needed; ___ ___ require consultation with their attending physician
- thyroid ptn w/ acute infection- ____ therapy w/ ____ to prevent ____ ___/____ and consultation regarding _____ is recommeded
- Required medical consultation prior to dental therpay for: ___/____ treated thyroid dx or ptns w/o ____ ___ or ___ follow up
- ptns with symptoms of thyroid disease (hypo or hyper) regardless of ___ of their most ___ __ ___ require reevaluation prior to ___ ___ ___
3) ___ and other __ __ are contraindicated in uncontrolled or poorly controlled hypertyhroid ptn
4) avoid use of ___,___, and ___ in uncontrolled hypothyroid ptn
- disease status, medications, follow up intervals
- indicated; pressor amines, barbituates, narcotics, sedative
- emergency care; acute infections
- conservative, antibiotics, thyroid crisis/myxedema; management
- untreated/incompletely, recent medical or lab
- timing, recent medical eval; any dental treatment - epinephrine, catecholamines
- narcotics, barbituates, tranquilizers
