a brief presentation about the question of "How to manage patients with hypo/hyper- thyroidim at dental office?"

1. THYROID DISEASES
CONSIDERATIONS IN DENTAL OFFICE
Khosravi,Vatankhah,Shafagh,Teymourshahi,Ghanbari,Babaeian

2. Intro.

3. Intro.
Primary goiter
Thyroid cancer
• hyperthyroidism
Thyrostimulatory
secondary goiters
(Graves)
• hypothyroidism
Thyroinvasive
Secondary goiters
(Hashimoto)
Other rare diseases

4. Intro.

5. Clinical features : Hyperthyroidism
skeletalCVSkeletal
GI
Osteoporosi
s
weight
loss,
increased
appetite,
Palpitation
Tachycardia
Hypertensio
n
Arrythmias
MI & CHF
Anxiety
Sleep
disturbance
s
Tremor

6. Clinical features : Hyperthyroidism
Increased
risk ofEyesSkin
Erythema
-Thin fine
hair
-Retraction
of upper
eyelid
-
Exophtalmo
s
-Corneal
ulceration
-Diabetes
-
Thrombocyt
openia
-Serum
cholesterol
level

7. Clinical features : Hypothyroidism
Musculo
skeletal
Arthritis,
muscle
cramps
CV
hypotensi
on, slow
pulse
GI
constipati
on,
anorexia

8. Clinical features : Hypothyroidism
CNS
mental and
physical
slowness,
sleepiness,
headache
General
dry, thick
skin and
dry hair;
fatigue
General
Edema
(puffy hand,
face,eyes) ,
cold
intoleranc
e;
hoarsenes
s;
weight

9. Tx. Of hyperthyroidism

10. Tx. Of hypothyroidism

13. Dental office considerations for
hyperthyroidism
■ Aspirin and other NSAIDs can increase the amount of circulating T4, making control of
thyroid disease more difficult. Use appropriately.
■ Ciprofloxacin should not be taken simultaneously with levothyroxine because the
antibiotic appears to decrease absorption of the thyroid hormone.
■ Avoid using epinephrine in local anesthetics in untreated and poorly controlled patients.
■ Excessive bleeding may occur in patients with untreated or poorly controlled disease
owing to thrombocytopenia, which, fortunately, is not a common finding.
■ Thyrotoxic crisis occurring in the dental office: Seek medical aid; vital signs must be
monitored and CPR initiated if necessary; apply wet packs or ice packs; inject 100 to 300
mg of hydrocortisone, IV glucose solution; administer propylthiouracil; and transport
patient to emergency medical facilities.

14. Dental office considerations for
hypothyroidism
■ Avoid CNS depressants such as narcotics, barbiturates, and sedatives in patients with
poorly controlled
■ 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).
■ Myxedema coma: Seek medical aid; vital signs must be monitored and 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.