From sproat's book

What is the function of the thyroid gland?

regulate metabolic functions = protein synthesis, regulate long bone growth, neural maturation
calcium homeostasis

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?

iodine deficiency
thyroid surgery
thyroidectomy
congenital
infective
infiltration (tumour)
secondary to hypopituitarism

What are the clinical features of hypothyroidism?

deep voice
mental slowness
cold intolerance
bradycardia
weight gain
constipation
dry thin hair
goitre
anaemia
pulmonary effusion
dry skin
menorrhagia

How is hypothyroidism diagnosed?

free t4 is low
TSH is high (primary hypothyroidism)

What is the treatment for hypothyroidism?

thyroxine - lifetime
monitored

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
-multinodular goitre
- acute thyroiditis
De Quervain's
- 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?

goitre
palpitations
weightloss
exophthalmos
heart failure
tremor
weight loss
warm vasodilator peripheries
irregularly irregular pulse
proximal myopathy

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?

asymptomatic usually
- moves on swallowing
- enlargement dur to thyoiditis
Multiple nodules = beningn multinodular goitre
single
Rarely = pain, swelling, lump in throat, stridor

What is the differential diagnopsis for thyroid nodules?

adenoma
cyst
carcinoma
multinodular goitre
hashimoto's thyroiditis
effect of previous operation or radioiodine therapy
parathyroid cyst or adenoma
thyroglossal cyst
aneurysm
laryngocele

What can icnrease the risk of malignant thyroid lump?

past history of neck radiation
family history of thyroid cancer
associated lymphadeopathy
high rate of growth
male
under 20 and over 60
pain
fixation to underlying muscles
hoarse voice
cold nodule scan

How is a thyroid lump investigaed?

CT scane
fine needle aspiration
ultrasound
thyroid function test
autoantibody detection

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?

post surgery
idiopathic/autoimmune
Rare = genetic (DiGeorge syndrome)

What are the clinical features of hypoparathyroidism?

Hypocalcaemia =
chvostec sign = twitching secondary to gentle tapping of facial nerve
trousseau's sign = carpal spasm when bp cuff is more than 20 mmHg
seizures
laryngospasm and bronchospasm
fatigue
hyperirritability
anxiety

How is hypoparathyroidism diagnosed?

serum ca
serum pth

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
HBP, hypocaclaemia
circumoral around mouth paraesthesia
chvostek signs and trousseaus sign
seizures fits
hoarse voice
autoimmune disease effects

What is hyperparathyroidm?

increased parathyoird hormone

What are the clinical features of hyperparathyroidism?

asymptomatic
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?

hyperparathyroidism
carcinoma
abnormal vit D metabolism
immobilisation
endocrine disorders
thiazide diurites
renal disease

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
splayed teeth
hypertension
diabetes

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
androgens

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

Hypotension
pigmentation = buccal mucosa, scars, palmer creases
thirst
loss of body hair
eright loss
anorexia and malaise

What is cushing's syndrome?

overproduction of cortisol

What are the clinical feautres of cushin's syndrome?

frontal balding
depresion
moon face
acne
plethora
thin skin
bruising
diabetes
osteoporosis
hypertension
weightgain
striae
proximal myopathy

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
childhood thing
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
OTHER
gestational
endocrinopathies = cushing's, increased glucagon, GH
drugs = steroids, thiazines

What arhe the main clincal features of DM?

tiredness/lethargy
polyuria
dehydration
weight loss (type 1)

What are the acute complications of diabtes mellitus?

hypoglycaemia
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
kidney failure
nerves = glove and stocking numbness
increased infection risk = dysfunction polymorphs, high glucose and poor blood supply
salivary gland dysfunction = xerostomia
burning mouth
increase lichen planus likelyhood
traumic oral ulcers
oral candidiasis

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
Oral manifestation
- xerostomia
- gingivitis
- increased periodontal disease
- candidiases
- 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.

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