Hyperthyroidism and Hypothyroidism ( thyroid diseases) management in dental office

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.

4. Intro.

5. Clinical features : Hyperthyroidism skeletal CV Skeletal GI Osteoporosis weight loss, increased appetite, Palpitation Tachycardia Hypertension Arrythmias MI & CHF Anxiety Sleep disturbances Tremor

6. Clinical features : Hyperthyroidism Increased risk of Eyes Skin Erythema -Thin fine hair - Retraction of upper eyelid - Exophtalmos -Corneal ulceration - Diabetes -Thrombocytopenia -Serum cholesterol level

7. Clinical features : Hypothyroidism Musculo skeletal Arthritis , muscle cramps CV hypotension, slow pulse GI constipation, 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 intolerance; hoarseness; weight gain

9. Tx . Of hyperthyroidism

10. Tx . Of hypothyroidism

11. 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.

12. 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.