Thyroid gland dysfunction2.

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Thyroid gland dysfunction2.

  1. 1. THYROID GLAND DYSFUNCTION
  2. 2. Outlines  Anatomy and structure  Physiology and function  Pathology of the gland  Clinical features  Hypo/ and hyper/ thyroidism  Management
  3. 3. Anatomy and structure of thyroid gland
  4. 4. Tertiary Secondary Primary
  5. 5. Thyroid gland dysfunction  Hormones:    Thyroxin [T4] Tri-iodo-thyronin [T 3] Calcitonin Dysfunction Hypo function-hypothyroidism  myxedema Hyper function--hyperthyroidism  Thyroid storm or crisis 
  6. 6. Hypothyroidism No adequate thyroid hormones  Causes :Lack of TH as in  1- thyroid gland diseases  [ primary Hypothyroidism]  -idiopathic atrophy… . [autoimmune]  -thyroidectomy, radiation,  -iodine deficiency  2- pituitary diseases [secondary--]  3- hypothalamus diseases [tertiary…]
  7. 7. Clinical features            All body functions slow down basic …..hypothermia, hypotension, hypoxia, bradycardia …. More in females, between 60—70 y Clinical p. In children------cretinism physical & mental retardation bone develop is delayed…. Teeth temperature is decreased tongue …is large skin thick…..myxedema seen later Face is broad & puffy
  8. 8. In adults------hypothyr [ MYXEDEMA]  weakness, fatigue  Nonpitting ,gelatinous mucinous infiltrates beneath the skin [myxod.]  Sudden increase of weight, without increased appetite  ---- myxedema coma 
  9. 9. Hyperthyroidism [thyrotoxicosis] Other names : toxic goiter, Basedow’s disease, Graves’ ,Parry’s , Plummer’s disease Excess Thyroid hormons especially T 4 & T 3  Clinical picture. :  All body functions are increased  More in females,  Between 20—40 y 
  10. 10. Increased body functions CNS : nervousness , irritable, tremors  Skin : hyperpyrexia [warm] , wet  CVS : blood pre increased, tachycardia  Eye manifestation: lid retraction  Severest complications thyroid crisis 
  11. 11. Clinic of hyperthr Ophthalmopathy: Lid retraction Staring exophthalmos
  12. 12. CN S Nervousness Tremors disorientation
  13. 13. prevention Medical history physical examination  In hypothy:-large thick tongue  thick , edematous, dry skin      In hyperthyr : -nervousness, tremors -warm,…..wet thin skin -blood pressure increased
  14. 14. DENTAL considerations In hypothyroidism  ask medical advise before dent treatment  avoid CNS depressant….  take care of CVS In hyperthyroidism  ask medical advise before dent treatment  avoid atropine and adrenaline  take care of CVS NB :hypothyr is more presenting in dentistry than hyperthyroidism, so more significant .
  15. 15. Management of hypothyroidism No specific manag for hypothyr…  if doubt ask medical advise  treatment by thyroid hormone  Pt. is sensitive to: sedatives, antihistamine, codeine  In unconscious patient  Terminate dental procedures  Supine position  A B C, assess and perform basic life support as needed  D : definitive management  Summoning of medical assistance  IV line: dextrose 5% or normal saline Administration of O2 massive dose of thyroid hormone in hospit for days 
  16. 16. Management of hyperthyroidism In unconscious patient  Terminate dental procedures  Supine position  A B C, assess and perform basic life support as needed  D : definitive management Summoning of medical assistance Administration of O2  transport to a hospital  1- Antithyroid drugs ex propylthiouracil  2-Propranolol [blocker of the TH receptors]  3-Glucocorticoids  Cold packs, Sedatives with careful monitoring of hydration and electrolyte balance NO DRUGS ARE USED IN MANAG OF THYR DIS IN DENTAL OFFICE 
  17. 17. DD altered conscious… Causes      Hyperventil Hypoglycemia and hyperglycemia Hypothyroidism and hyperthyroidism Cerebrovascular accidents Drugs and allergic reactions
  18. 18. Important points in differential diagnosis       History age 0-14 : …….hypoglycemia insulin depend 14-40 hyperventilation 20-40 hyperthyroidism above 40 ….diabetes or Cerebrovascular accidents Sex female ---- hyperthyroidism
  19. 19.            Stress Hyperventilation Cerebro-vascular accidents Hyperthyroidism Onset gradual: hyperglycemia [hours, days] hyperthyroidism [days, months] Cerebro-vascular accidents [/?days, weeks] rapid Hyperventilation Hypoglycemia Cerebro-vascular accidents Thyroid storm
  20. 20.  Temperature & sweating Co w Hypoglycemia Hyperglycemia Hot D Co D Hypothyroidism Hyperthyroidism Hot W
  21. 21. Anxiety:  Hypoglycemia  Hyperthyroidism  Hyperventilation Vital signs  Respiration rate: increased  slow hyperventilation CVA, drugs   Blood pressure:  increased hyperventilation & hyperthyroidism
  22. 22.  Heart  Rate Increased Hyperventilation  Hypoglycemia  Hyperglycemia   Slow  Hypothyroidism
  23. 23. ‫محطة الحجاز في دمشق‬ ‫قبل مئة عام‬ ‫اآلن‬

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