What is the function of the thyroid gland?
regulate metabolic functions = protein synthesis, regulate long bone growth, neural maturation
What is the basic physiology of thyroid secretion
Hypothalamus --> TRH
pituitary gland --> TSH
thyroid gland --> T3 and T4 (-ve feedback to hypothal and pituitary gland)
liver - insuline-like hormone
What is hypothyroidism?
Under production of thyroid hormone?
What are the causes of hypothyroidism?
secondary to hypopituitarism
What are the clinical features of hypothyroidism?
dry thin hair
How is hypothyroidism diagnosed?
free t4 is low
TSH is high (primary hypothyroidism)
What is the treatment for hypothyroidism?
thyroxine - lifetime
What is the dental relevance of hypothyroidism?
-children = delayed dental development and increased decay
- adult = enlarged tonne, delayed eruption, delayed wound healing, changed taste
- sever hypothyroidism = avoid Dental tx because of myxoedema coma
- can be sensitive to sedatives and opiod analgesics
- lower pain threshold
What is hyperthyroidism?
Excess levels of thyroid hormone is produces
more common in women
what are the causes of hyperthyroidism?
- Graves' disease = Ig antibodies against TSH receptors
- solitary toxic nodules/ adenoma
- acute thyroiditis
- too much thyroxine intake
- too much exogenous iodine
How is hyperthyroidism diagnosed?
increased T3 and T4 levels
What are the signs and symptoms for hyperthyroidism?
warm vasodilator peripheries
irregularly irregular pulse
WHat is the treatment for hyperthyroidism
- Antithyroid drugs = carbimazole + beta blocker to down the sympathetic system
- radioactive iodine = goes in throid gland and destroys the gland // need to be euthyroid before treatment
surgery - partial thyroidectomy
What is the dental relevance of hyperthyroidism?
- increased periodontal disease
- premature tooth eruption
- avoid in sever hyperthyroidism = risk of thyrotoxicity = caused by stress = medical emergency
- pt sensitive to adrenaline
whaty are the clinical features of thyroid lump?
- moves on swallowing
- enlargement dur to thyoiditis
Multiple nodules = beningn multinodular goitre
Rarely = pain, swelling, lump in throat, stridor
What is the differential diagnopsis for thyroid nodules?
effect of previous operation or radioiodine therapy
parathyroid cyst or adenoma
What can icnrease the risk of malignant thyroid lump?
past history of neck radiation
family history of thyroid cancer
high rate of growth
under 20 and over 60
fixation to underlying muscles
cold nodule scan
How is a thyroid lump investigaed?
fine needle aspiration
thyroid function test
What is the treatment for a benign thyroid lump?
close observation if asymptomatic
toxic nodules removed surgically/ radioiodine
thyroid cyst = aspiration
What is the dental relevance of thyoid nodule?
picked up during routine exams
swelling at the base of the tongue may be due to accessory thyroid tissye left at the foramen caecum
What is the parathyroid gland?
located at each pole of thyroid glands, they are central to caclium regulation
What is hypoparathyroidism?
reduced parathyroid secretion
What are the common causes of hypoparathyroidism?
Rare = genetic (DiGeorge syndrome)
What are the clinical features of hypoparathyroidism?
chvostec sign = twitching secondary to gentle tapping of facial nerve
trousseau's sign = carpal spasm when bp cuff is more than 20 mmHg
laryngospasm and bronchospasm
How is hypoparathyroidism diagnosed?
What is the treatment for hypoparathyroidism?
check Ca every 6 months
calcium and vitamin D supplements
What is the dental relevance of hypoparathyroidism in dentistry?
cadidosis of mouth and hands
circumoral around mouth paraesthesia
chvostek signs and trousseaus sign
autoimmune disease effects
What is hyperparathyroidm?
increased parathyoird hormone
What are the clinical features of hyperparathyroidism?
bones - salt pepper skull, subperiostal resorption of distal phalanges
stones = renal stones
groans = malaise weakness depression
abdominal moans = peptic ulcerations
What are some of the causes of hypercalcaemia?
abnormal vit D metabolism
What is the dental relevance of hyperparathyoidism?
brown tumours of mandible and maxilla
loss of lamina dura around the teeth
ostopenia = bone loss is faster than formation
associated with aids = oral complications
What are the effects of hypopituitaryism?
reduced LH and FSH = loss of
- inreased prolactin = galactorrhoea and hypogonadism
- decrease GH - retarded growth
- decrease TSH = hypothyroidm
- decrease ACTH = reduced adrenal function
What is cranial diabetes insipidus
lack of vasopressin (ADH) = polyuria, nocturia and increased thirst
urine output = 10L
increase consequence of renal disease
What is acromegaly>
Increased GH secretion usually caused by the pituitary
What are the clinical features of acromegaly?
large hands feet
coarse facial features
overbite of lower jaw
What is hypopituitariam?
Deficiency of hypothalamic releasing hormone or pituitary hormones = selective or multiple
usually caused by tumours surgery or radiotherapy
What is the dental relevance of pituitary disease?
growth in facial structures e.g. acromegally = denture wearing, bridges, ortho work is difficult to carry out
XLA = difficult due to ankylosing
Dental management complicated by multiple endocrine problems e.g. hypertension, cardiac complication and arthritis
What do the adrenal glands do and what do they control?
glucocorticosteroids = metabolism, fluid balance and immune response
mineralacorticosteroids= affects sodium and potassium balance
What is addison's disease?
reduce corticosteroid secretion
How is addison's diagnosed?
plasma cortisol measurement
ACTH stimulation test
What are the clinical features of addison's disease
pigmentation = buccal mucosa, scars, palmer creases
loss of body hair
anorexia and malaise
What is cushing's syndrome?
overproduction of cortisol
What are the clinical feautres of cushin's syndrome?
What is the dental relevance of adrenal disease>
oral steroids = prone to infection
addisons = oral pigmentation
What is diabetes mellitus?
Raised serum glucose of >11mmol at random or more than 7mmol for fasting glucose
What types of diabetes are there and state the difference?
Type 1 = IDDM
autoimmune destruction of b cells from islet of langerhan
commonly have other autoimmune disease
Type 2 - NIDDM
reduced sensitivity to insulin and reduced production
increased risk with age, diet, exercise obesity
there is a strong genetic predisposition
endocrinopathies = cushing's, increased glucagon, GH
drugs = steroids, thiazines
What arhe the main clincal features of DM?
weight loss (type 1)
What are the acute complications of diabtes mellitus?
autonomic symptoms (sweating, shaking, palpitations)
neurologocical symptoms( confusion, seizures, coma)
diabetic ketoacidosis (IDDM)
hyperosmolar non ketotic coma
What are the chronic complications of diabetes?
increased risk of stroke, MI , foot amputation
retina loss of vision
nerves = glove and stocking numbness
increased infection risk = dysfunction polymorphs, high glucose and poor blood supply
salivary gland dysfunction = xerostomia
increase lichen planus likelyhood
traumic oral ulcers
How is diabetes managed?
type 1 = insulin = lasting different durations
type 2 = modify risk factors and reduce diet sugars
medformin = biguanides (increase insulin sensitivity)
sulphonylureas (increase insulin secretion and sensitivity)
What is the dental relevance of treating a patient with diabetes?
- morning appointments
- make sure meds are taken as usual
- make sure they've had a meal to eat
- increased periodontal disease
- poor wound healing
- burning mouth or tongue
Avoid sedation = if they have GA make sure they are on an insulin sliding scale and it is monitored.
Infections should be treated vigorously.