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Management of patients with thyroid disorders /certified fixed orthodontic courses by Indian dental academy


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Management of patients with thyroid disorders /certified fixed orthodontic courses by Indian dental academy

  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. INTRODUCTION      Two elongated lobes Either side of trachea Isthmus of thryroid tissue Below the level of the thryoid cartilage Secretes three hormones Thyroxine (T4) Triiodothyronine (T3) Calcitonin
  4. 4. DYSFUNCTION OF THYROID GLAND UNDERPRODUCTION Clinical state in which the tissues of the body do not receive an adequate supply of thyroid hormones. OVERERPRODUCTION State of heightened thyroid gland activity associated with the production of excessive quantities of the thyroid hormones T4 and T3.
  5. 5. HYPOTHYROIDISM The clinical signs and symptoms are related to the age of the patient at the time of onset and to the degree and duration of the hormonal deficiency •Adults – Myxoedema •Infants – Cretenism complication-Myxoedema coma
  6. 6. DIAGNOSTIC CLUES       Cold intolerance Weakness Fatigue Dry, cold, yellow , puffy skin Thick tongue Bradycardia
  7. 7. MANAGEMENT OF HYPOTHYROIDISM   No special management is necessary for most patients who exhibit clinical evidence. Effective management is achieved through oral administration of desiccated thyroid hormone for lifetime of the patient.
  8. 8. DENTAL CONSIDERATION Patients are sensitive to following drugs. Normal dosage may prove to be an overdose, leading to respiratory or cvs depression or both. Sedatives (eg., barbiturates) Narcotics(eg.,Meperidine,codeine) Antianxiety (eg.,diazepam) CNS depressants
  9. 9. MYXEDEMA COMA         Final stage of severe, long standing hypothyroidism Intensive care setting CPR Hypothermia – passive rewarming with blankets Hypotension – volume expansion with saline, dopamine administration Hypoxia and hypercapnea – tracheal intubation and mechanical ventilation Thyroid hormone therapy Thyroxine (T4; Synthroid) - 500µg IV loading dose followed by 1.5 to 2µg/kg/day IV Triiodothyronone (T3 ; Triostat) – 25 to 50µg every 8hrs IV Glucocorticoid therapy (100mg of IV hydrocortisone every 8hrs ) – To overcome Adrenal insufficiency Oral medication – 1.5 to 2 µg/kg/day of thyroxine
  10. 10. HYPERTHYROIDISM The clinical signs and symptoms may be noted in any part of the body, because the thyroid hormones affect the cellular metabolism of virtually all organ systems Also known as Thyrotoxicosis Toxic goitre(diffuse or nodular) Basedow’s disease Grace’s disease Parry’s disease Plummer’s disease Complication – Thyroid “storm” or crisis
  11. 11. DIAGNOSTIC CLUES       Sweating Heat intolerance Tachycardia Warm, thin, soft, moist skin Exophthalmos Tremor
  12. 12. MANAGEMENT OF HYPERTHYROIDISM I. Continuation of anti-thyroid drugs (To restore the patient to euthyroid state) ~ propyl thiouracil 200mg three times daily ~ potassium percholate 200mg three times daily with maintenance dose of 200 to 400mg daily II. Surgery – Subtotal thyroidectomy III. Radio-iodine 150µcuries/g
  13. 13. DENTAL CONSIDERATION    Dental care should not take place until metabolic disturbance is corrected Acute anxiety – Increase in clinical risk Drugs not to be administered ~Atropine – vagolytic agent hence increases the heart rate and may precipitate thyroid storm ~Vasopressors – CVS stimulant and may precipitate cardiac dysarhythmias, tachycardia and thyroid storm Sedative drug effectiveness is less than ideal.
  14. 14. THYROTOXIC STORM It is the state of acute decompensation of the CVS, GIT, hepatooral, and CNS in a thyrotoxic patient. Triggered by a condition of medical, surgical, dietary stress in a thyrotoxic patient leading to ~Elevated free thyroxine levels ~Decreased hepatic clearance of iodothyronines ~Increased formation of iodothyronines
  15. 15. TREATMENT OF THYROTOXIC STORM       First drug of choice – propanolol ( IV 1mg/min with total dose of 2 to 10mg) to control cardiac and psychomotor manifestations of storm. Hydrocortisone IV 100 to 300mg – treating hyperpyrexia Sodium iodide IV 1 to 2g Placing the patient on a cooling blanket, alcohol bath Administer Oxygen Transport to hospital for further management
  16. 16. Thank you Leader in continuing dental education