Endocrinal System
Thyroid and Parathyroid

www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Thyroid
• Endocrine gland situated in the neck.
• Two lobes joined by an isthmus.
• Secretes two hormones
Thyroxine(T3) an...
Regulation of thyroid gland
activity
• Thyroid gland is an effector component of
classic hypothalamic-anterior pitutaryper...
Actions of thyroid hormone
•
•
•
•

Whole body actions :
Increase the whole body consumption of
Oxygen and heat production...
Effects on growth and development
• Stimulates linear growth, development and
maturation of the bone.
• Accelerates secret...
Disorders of thyroid function
• Hyperthyroidism :
• More common in women in the age range
of 20-40 years.
• Three conditio...
• Clinical features :
• Characteristic eye changes- Exoptholmous,
limitation of ocular movement and
optholmoplegia.
• Incr...
•
•
•
•
•
•
•
•
•

Management :
Antithyroid drugs – Carbimazole
Beta blockers
Radioactive iodine
Total or subtotal thyroid...
Hypothyroidism
• Commonest cause is chronic autoimmune
hypothyroidism- two clinical forms
Goitrous form (Hashimoto’s disea...
• Clinical features :
• Often unrecognized
• Weight gain, lassitude, dry skin and loss of
hair.
• Bradycardia and heart fa...
• Dental aspects :
• Main danger is of precipitating myxoedema
coma by sedatives(diazepam), opioids,
tranquillizers and ge...
Parathyroids
• Four pea-sized glands located on the back
of thyroid gland.
• Secrete parathyroid hormone(PTH).
• Secretion...
• Actions of PTH :
• Acts on kidneys, GIT and bone.
• PTH and vit D both act to control plasma Ca
levels.
• Increases rena...
Hypoparathyroidism
• Most common cause is thyroidectomy.
• Muscle irritability and tetany is the classical
feature with
Fa...
• Diagnosis and management :
• Blood biochemistry
Low plasma calcium and often raised
phosphate.
• Therapy :
Replacement t...
• Dental aspects :
• LA is safe
• Dental management may be complicated by
tetany, Seizures, psychiatric problems and
learn...
Hyperparathyroidism
• Three types –
Primary hyperparathyroidism : usually
caused by a parathyroid adenoma seen in
post men...
• Clinical features :
• “Stones, bones and abdominal groans”
• Hypercalcaemia leading to
Renal disease – renal calcificati...
• Diagnosis :
• Confirmed by raised parathyroid hormone
levels – raised serum calcium. Plasma
phosphate levels may be low....
Dental aspects
• LA is preferred over GA.
• Dental treatment may be complicated by
Renal disease – may impair drug excreti...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Endocrinal system /certified fixed orthodontic courses by Indian dental academy

527 views
284 views

Published on

The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Published in: Education, Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
527
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Endocrinal system /certified fixed orthodontic courses by Indian dental academy

  1. 1. Endocrinal System Thyroid and Parathyroid www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Thyroid • Endocrine gland situated in the neck. • Two lobes joined by an isthmus. • Secretes two hormones Thyroxine(T3) and Triiodothtroxine(T4) www.indiandentalacademy.com
  4. 4. Regulation of thyroid gland activity • Thyroid gland is an effector component of classic hypothalamic-anterior pitutaryperipheral gland axis. • Major stimulator- TSH or thyrotropin from anterior pitutary. • Direct stimulator for TSH is TRH or thyrotropin-releasing harmone from hypothalamus. • Negative feedback mechanism. www.indiandentalacademy.com
  5. 5. Actions of thyroid hormone • • • • Whole body actions : Increase the whole body consumption of Oxygen and heat production. Increase the cardiac output. Accelerates the response to starvation. Metabolic disposal of other hormones and many drugs are increased. www.indiandentalacademy.com
  6. 6. Effects on growth and development • Stimulates linear growth, development and maturation of the bone. • Accelerates secretion of growth hormone. • Normal skeletal muscle function also requires thyroid. • Has critical effects on the development of CNS. • Contributes to the reproductive function of both genders. www.indiandentalacademy.com
  7. 7. Disorders of thyroid function • Hyperthyroidism : • More common in women in the age range of 20-40 years. • Three conditions account for most cases Grave’s disease Toxic multinodular goitre Solitary toxic nodule www.indiandentalacademy.com
  8. 8. • Clinical features : • Characteristic eye changes- Exoptholmous, limitation of ocular movement and optholmoplegia. • Increase in BMR • Heightened level of anxiety and restlessness • Intolerance to heat. • Pretibial myxoedema www.indiandentalacademy.com
  9. 9. • • • • • • • • • Management : Antithyroid drugs – Carbimazole Beta blockers Radioactive iodine Total or subtotal thyroidectomy. Dental aspects : GA is risky – chances of dangerous dysrythmias Sedation may be necessary – N20 is safer Risk of giving adrenaline containing LA is more of theoretical risk. • Thyroid crisis !!! www.indiandentalacademy.com
  10. 10. Hypothyroidism • Commonest cause is chronic autoimmune hypothyroidism- two clinical forms Goitrous form (Hashimoto’s disease) & Atrophic form • Other causes – surgical removal, radiation, iodine deficiency and some drugs. • Common in women in the age group 60 yrs www.indiandentalacademy.com
  11. 11. • Clinical features : • Often unrecognized • Weight gain, lassitude, dry skin and loss of hair. • Bradycardia and heart failure. • Neurological and psychological changes like sleeplessness, irritability and mental dullness. • Hoarseness,hypothermia and cold intolerance. • Associated autoimmune disease like Sjogren’s syndrome. www.indiandentalacademy.com
  12. 12. • Dental aspects : • Main danger is of precipitating myxoedema coma by sedatives(diazepam), opioids, tranquillizers and general anaesthetics. • Local anaesthesia is safe and preferrable. • Stunted growth is most marked feature of cretinism.Also eruption and shedding of primary teeth are delayed. • Additional problems may be posed by associated hypopitutarism and Sjogren’s syndrome. www.indiandentalacademy.com
  13. 13. Parathyroids • Four pea-sized glands located on the back of thyroid gland. • Secrete parathyroid hormone(PTH). • Secretion is controlled by negative feed back mechanism. Stimulated by fall in the plasma ionized calcium. www.indiandentalacademy.com
  14. 14. • Actions of PTH : • Acts on kidneys, GIT and bone. • PTH and vit D both act to control plasma Ca levels. • Increases renal re absorption of calcium and impairs phosphate re absorption. • Enhances GI absorption of calcium. • Promotes osteoclastic bone resorption which is reflected in a rise in plasma level of calcium and alkaline phosphatase enzyme. www.indiandentalacademy.com
  15. 15. Hypoparathyroidism • Most common cause is thyroidectomy. • Muscle irritability and tetany is the classical feature with Facial twitching(Chvostek’s sign) Carpopedal spasms(Trousseau’s sign) Numbness and tingling of arms and legs • Other uncommon features like Psychiatric disorders Dental defects www.indiandentalacademy.com Constipation Etc.
  16. 16. • Diagnosis and management : • Blood biochemistry Low plasma calcium and often raised phosphate. • Therapy : Replacement therapy includes Vit D and calcium supplements. Vit D 500-3000 micrograms/day, Calcium 2-3 gms/day. www.indiandentalacademy.com
  17. 17. • Dental aspects : • LA is safe • Dental management may be complicated by tetany, Seizures, psychiatric problems and learning disabilities. • Congenital forms may feature enamel hypoplasia, shortened roots and sometimes delayed eruption. www.indiandentalacademy.com
  18. 18. Hyperparathyroidism • Three types – Primary hyperparathyroidism : usually caused by a parathyroid adenoma seen in post menopausal women. Secondary hyperparathyroidism : is a response to plasma low calcium levels secondary to chronic renal failure or prolonged dialysis. Tertiary hyperparathyroidism : follows prolonged secondary hyperparathyroidism that has become autonomous. www.indiandentalacademy.com
  19. 19. • Clinical features : • “Stones, bones and abdominal groans” • Hypercalcaemia leading to Renal disease – renal calcifications (stones) Skeletal disease – bone pain, pathological fractures and giant cell tumors. GI - Peptic ulcers and pancreatitis. Others – hypertension and sometimes dysrhythmias. • Hyperparathyroidism may sometimes be associated with tumors of other endocrine glands (MEN I, II and III). www.indiandentalacademy.com
  20. 20. • Diagnosis : • Confirmed by raised parathyroid hormone levels – raised serum calcium. Plasma phosphate levels may be low. • Enzyme alkaline phosphatase level will be normal unless there is significant bony involvement. • Management : • Surgical : Parathyroidectomy. • Medical : active Vit D hormone(1,25dihydroxycholecalciferol). Also hydration, increased salt intake and mild forced diuresis. www.indiandentalacademy.com
  21. 21. Dental aspects • LA is preferred over GA. • Dental treatment may be complicated by Renal disease – may impair drug excretion. Peptic ulceration – may limit the choice of analgesics. Bone fragility – pathological fractures. • Dental changes : • Loss of lamina dura and generalized bone rarefaction. • Giant - cell lesions of hyperparathyroidism (Browns tumor). www.indiandentalacademy.com
  22. 22. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

×