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. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 00919248678078

1. MANAGEMENT OF
PATIENTS WITH
THYROID DISORDER
www.indiandentalacademy.com

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

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
www.indiandentalacademy.com

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.
www.indiandentalacademy.com

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
www.indiandentalacademy.com

6. DIAGNOSTIC CLUES






Cold intolerance
Weakness
Fatigue
Dry, cold, yellow , puffy skin
Thick tongue
Bradycardia
www.indiandentalacademy.com

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.
www.indiandentalacademy.com

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
www.indiandentalacademy.com

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
www.indiandentalacademy.com
Oral medication – 1.5 to 2 µg/kg/day of thyroxine

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
www.indiandentalacademy.com

11. DIAGNOSTIC CLUES






Sweating
Heat intolerance
Tachycardia
Warm, thin, soft, moist skin
Exophthalmos
Tremor
www.indiandentalacademy.com

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
www.indiandentalacademy.com

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.
www.indiandentalacademy.com

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
www.indiandentalacademy.com

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
www.indiandentalacademy.com

16. Thank you
www.indiandentalacademy.com
Leader in continuing dental education
www.indiandentalacademy.com