Part II- Thyroid Disease- Endocrine and Metabolic conditions

Question 1

What is the function of the thyroid gland?

Answer 1

• Secretes T4, T3 and calcitonin (Thyroid hormones)
• Affects growth and maturation of tissues, cell respiration and energy expenditures

Question 2

What is goiter?

Answer 2

Generalized enlargement of the tyroid gland

Question 3

What is Thyrotoxicosis?

Answer 3

Excess of T4 and T3 in the blood;
hyperthyroidism

Question 4

What is Graves disease?

Answer 4

Autoimmune disease associated with
excess thyroid hormones and enlarged thyroid

Question 5

What is hypothyroidism?

Answer 5

low T4 and T3 blood plasma levels

Question 6

What is Myxedema

Answer 6

Severe hypothyroidism; dermatologic
changes that occur with hypothyroidism.

Question 7

What is Hashimoto Thyroiditis?

Answer 7

Autoimmune disorder that
causes hypothyroidism

Question 8

What is Thyroiditis?

Answer 8

Inflammation of the thyroid

Question 9

What is Hyperthyroidism associated with?

Answer 9

• associated with graves diease, toxic nodular goiter and acute thyroiditis

Question 10

What is Hyperthyroidism caused by?

Answer 10

• Caused by: eating large amount of ground beed or functional ectopic thyroid tissue

Question 11

What does Hyperthyroidism cause?

Answer 11

• Nervousness
• Fatigue
• Heart palpitations
• Heat intolerance
• weight loss
• Sweating
• Soft fingernails
• Thin hair
• Loss of vision
• Can be continous

Question 12

What are Hyperthyroidism symptoms for the eyes and skin?

Answer 12

Eye: staring
Infrequent blinking
Jerky eyelid movement
Failure to wrinkle the brow when gazing upward

Skin: warm, rosy complexion

Question 13

Patients with hyperthyroidism show signs of ?

Answer 13

• Being nervous or easily to lose temper or cry
• Difficulty sitting still
• Hand and tongue tremors
• Increase bone loss due to excretion of calcium in urine
• intolerant to gluclose

Question 14

What is “thyroid storm”?

Answer 14

If hyperthyroidism not controlled can become a medical emergency because PT may have restlessness, fever, tachycardia, pulmonary edmea, tremor, sweating, stupor, coma and or death.

Question 15

What are some medical management for Hyperthyroidism?

Answer 15

• Anti-thyroid agents: Propylthiouracil and Methimazole
• Radioactive iodine (RAI)
• Thyroidectomy (after antithyroid drug treatment)
• Management of thyrotoxic crisis as indicated: Serious complication of hyperthyroid treatment

Question 16

What are the dental Management for hyperthyroidism?

Answer 16

• Risk for infection is no greater; consult with physician if the patient is not controlled before treating an infection
• Bleeding is not a concern unless taking Coumadin
• Able to provide care if controlled; risk of thyroid storm medical emergency is not controlled
• Epinephrine is okay if the condition is controlled- consult with physician if not controlled
• Be prepared to manage thyroid storm by recognizing the signs
• Activate emergency medical treatment and call 911

Question 17

What are some oral manifestations for Hyperthyroidism?

Answer 17

• Babies may have teeth at birth
• Children: teeth and jaws develop faster
• Deciduous teeth are lost early, and permanent teeth erupt early
• Lingual thyroid may be present
• Possible change in taste and smell
• May develop periodontal disease and caries more rapidly

Question 18

Thyroiditis is?

Answer 18

• Autoimmune disorder, comes from asymptomatic goiter known as Hashimotos disease
• affects young and middle aage women
• progessive to hypothyroidism
• Goiter is main symptom

Question 19

What are oral manifestations of thyroiditis?

Answer 19

• Salivary gland disfunction
• Dry mouth
• Pain radiating to the ear, jaw or eyes
• Hoarseness
• Dysphagia
• Enlarged, firm nodular tender thyroid

Question 20

What are signs and symptoms for hypothyroidism in older children and adults ?

Answer 20

• Weight gain
• muscle weakness
• Deafness
• Anemia
• Constiplation
• Dull expression
• Puffy eyelids
• Dry rough skin
• Dry, Brittle hair
• Alopecia of eyebrows
• increase tongue size
• slowing of activity
• slurred hoarse speech
• Increase sensitivity to cold

Question 21

What are the medical management for Hypothyroidism?

Answer 21

• Synthetic thyroid hormone: Sodium levothyroxine (LT4): Sodium liothyronine (LT3)
• Need lower insulin or glucose lowering medications for diabetic patients
• Myxedema may lead to CHF; Levothyroxine can help decrease
• Hypothyroidism causes sensitivity to narcotics, barbiturates, and tranquilizers
• Smoking makes condition worse

Question 22

What is Myxedema coma?

Answer 22

• Stressful situations induced in untreated hypothyroid patients
  -High mortality
  -Treated by levothyroxine injection

Question 23

What are the dental mangament for Hypothyroidism?

Answer 23

• No antibiotics if uncontrolled; risk for myxedema coma
• Minimal bleeding risk
• Do not treat if not controlled or no medical management: May result in myxedematous coma
• If uncontrolled/untreated patient may experience exaggerated response to some drugs
• Be prepared to manage medical emergency: myxedema coma; know signs and symptoms

Question 24

What are the oral manifestaion of hypothyroidism?

Answer 24

Thick lip infants
Enlarged tongue-inflants and adults
Low salovary flow- adults

Question 25

What is Thyroid cancer caused by?

Answer 25

Caused by receiving cervical radiation in
childhood including multiple dental x-rays before
1970 and mandibular imaging

Question 26

What are the risk factors for thyroid cancer?

Answer 26

History of thyroiditis, very high or low iodine intake,
and family history of thyroid cancer

Question 27

What type of cancer may metastasize to the thyroid?

Answer 27

Distant cancers

Question 28

What is the presentation of thyroid cancer?

Answer 28

Firm irregularly shaped nodules in the thyroid that
are fixed to the underlying tissue, hard painless
max, attached to other local structures, enlarged
lymph nodes

Question 29

How is thyroid cancer diagnose and treated?

Answer 29

• Diagnosed after ultrasound and biopsy
• Treated surgically with lobectomy or complete
  thyroid removal