Thyroid & Adrenals

Question 1

What is the function of thyroid?

Answer 1

T3 & T4 prodcution which control metabolism.
Calcitonin production which regs Ca by decreasing it.

Question 2

Hypothyroidism causes

Answer 2

Autoimmune
Thyroidectomy
Radioactive iodine
Radiotherapy
Tumour

Question 3

Hyperthyroidism

Answer 3

• Grave’s disease (autoimmune dis where Ab stimulate thyroid)
• Toxic nodular goitre
• Toxic adenoma

Question 4

Hypothyroid symptoms

Answer 4

Body slows down
- Goitre (if TSH high but T3 T4 low)
- Weight gain
- Low mood / depression
- Cold
- Acne
- Dry skin and hair
- Bradycardia
- Tired/lethargic
- Muscle weakness

Question 5

Hyperthyroid symptoms

Answer 5

Body speeds up
- Goitre
- Weight loss
- Sweats
- Increase appetite
- Palps
- Anxious and irritable
- Muscle weakness and atrophy
- Sleeping difficulty

Question 6

How do you test for thyroid condition

Answer 6

Test T3 T4 levels.
If abnormal then check for tumour with MRI.

Question 7

Hypothyroidism dental complications

Answer 7

Delayed eruption
Enamel hypoplasia
Macroglossia
Micrognathia
Thick lips
Dysgeusia (taste disorder)

Question 8

Hyperthyroidism dental complications

Answer 8

Early eruption
Jaw osteoporosis
More caries and perio
Sensitivity to LA (epinephrine)

Question 9

How do you treat thyroid conditions?

Answer 9

Hypo = hormone replacement

Hyper = Radioactive iodine, thyroidectomy, anti-thyroid drugs.

Question 10

What’s the function of the adrenal glands

Answer 10

Produce cortisol to regulate stress.

Cortisol causes release of blood sugars in stress situation.

Question 11

Tests for adrenal deficiency

Answer 11

Check cortisol levels. MRI or CT of adrenal glands.

Question 12

What is Cushing’s syndrome?
What are typical signs and symptoms?

Answer 12

A condition in which too much cortisol is produced. Usually due to pituitary tumour.

• Round moon/cushion face
• Weigh gain
• Easy bruising
• Acne
• Hypertension
• Glucose intolerance
• Menstruation problems
• Striae/stretch marks

Question 13

How to test for Cushing’s

Answer 13

Check hormone levels (cortisol and ACTH).
MRI or CT if hormone levels abnormal.

What would you do a scan of if ACTH high?

Question 14

What’s the difference between primary and secondary adrenal deficiency?

Answer 14

Primary = problem with adrenal.

Secondary = insufficiency of adrenals is caused by problem elsewhere (pituitary tumour)

Question 15

What is Addison’s disease

Answer 15

Primary adrenal insufficiency

Question 16

What can cause Addison’s

Answer 16

Autoimmune
Tuberculosis
Fungal infections
Adrenal hemorrhage
Congenital adrenal hypoplasia
Sarcoidosis
Amyloidosis
Metastatic neoplasia

Question 17

What can cause secondary adrenal insufficiency?

Answer 17

• Chronic steroid treatments
• After treatment of Cushing’s
• Hypothalamic or pituitary tumours

Question 18

Signs or grave’s disease

Answer 18

Diffuse goitre
Bulging eyes (exomphalos)
Redness on shins

Question 19

Clinical features of adrenal insufficiency

Answer 19

Skin pigmentation
Weight loss
Hypotension
Hypoglycaemic episodes
Vomiting
Salt cravings

Question 20

A pt on chronic steroid medication that has adrenal insufficiency (or Cushing’s) is due for a dental procedure. What cover should be taken?

Answer 20

Simple procedure = double dose for 1h before surgery and 24h after.

Major procedure = intermuscular 100mg hydrocortisone then every 6 hours until well then double dose of oral steroids for 24-48 hours.