CPR Forth Year

1. THYROID GLAND
DYSFUNCTION

2. Outlines
 Anatomy and structure
 Physiology and function
 Pathology of
the gland
 Clinical features
 Hypo/ and hyper/ thyroidism
 Management

3. Anatomy and structure of thyroid gland

4. Tertiary
Secondary
Primary

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. 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. 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. In adults------hypothyr [ MYXEDEMA]

weakness, fatigue

Nonpitting ,gelatinous mucinous
infiltrates beneath the skin [myxod.]

Sudden increase of weight, without
increased appetite

---- myxedema coma


13. 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


14. Increased body functions
CNS : nervousness , irritable, tremors
 Skin : hyperpyrexia [warm] , wet
 CVS : blood pre increased, tachycardia
 Eye manifestation: lid retraction
 Severest complications
thyroid crisis


15. Clinic of hyperthr
Ophthalmopathy:
Lid retraction
Staring
exophthalmos

17. CN S
Nervousness
Tremors
disorientation

19. 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

20. 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 .

21. 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


22. 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


23. DD altered conscious…
Causes





Hyperventil
Hypoglycemia and hyperglycemia
Hypothyroidism and hyperthyroidism
Cerebrovascular accidents
Drugs and allergic reactions

24. 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

25. 
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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

26. 
Temperature & sweating
Co w
Hypoglycemia
Hyperglycemia
Hot D
Co D
Hypothyroidism
Hyperthyroidism Hot W

27. Anxiety:
 Hypoglycemia
 Hyperthyroidism
 Hyperventilation
Vital signs
 Respiration rate:
increased
 slow
hyperventilation
CVA, drugs


Blood pressure:

increased
hyperventilation & hyperthyroidism

28.  Heart

Rate
Increased
Hyperventilation
 Hypoglycemia
 Hyperglycemia


Slow

Hypothyroidism

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