Diseases Of Thyroid Gland Lecture PDF

DISEASES OF THYROID GLAND MOHAMED ABDELHALEEM MEDICALLY COMPROMISED PATIENTS Lecture contents: Objective Anatomy - Physiology Types of thyroid gland diseases Diagnosis Complications Treatment...

DISEASES OF THYROID GLAND MOHAMED ABDELHALEEM MEDICALLY COMPROMISED PATIENTS Lecture contents: Objective Anatomy - Physiology Types of thyroid gland diseases Diagnosis Complications Treatment dental management Oral/Orofacial manifestations  Types of thyroid gland diseases Types of thyroid gland diseases Objective Hyperthyrodism 2 Anatomy - Physiology Hypothyrodism Either: Primary (thyroiddisease). 3 Types of thyroid gland diseases Secondary (hypothalamic or pituitary).  Diagnosis 2-Laboratory test: Diagnosis -TFT ; Thyroid 4 hormones -Thyroid antibody test 5 Complications -Thyroid binding globulin 6 Treatment -Ultrasound -Thyroid scan using iodine  Hypothyrodism Hyperthyrodism Diagnosis -Diagnosis by: -Diagnosis by: Low serum T3 and T4. Raised serum levels of T3 and T4. 4 Diagnosis Serum antibodies for the Circulating autoantibodies in Hashimotos thyroiditis. Graves’s disease. 5 Complications Radioactive iodine uptake test. Thyroid scan. 6 Treatment TSH is high in the primary hypothyroidism and low in the secondary.  Hypothyroid : Hyperthyroid: Decreased metabolic rate. Increased appetite. Weight gain. Weight loss. Diagnosis Neurological and psychiatric Diagnosis Nervousness, Irritability. 4 abnormalities..Psychosis. Tremor. Decreased ability to adapt to cold. Intolerance to heat. 5 Complications Hypothermia. Dry skin. Excess sweating Warm moist skin. 6 Treatment Loss of hair. Exopthalmus. (Bulging eyes). Hoarseness. Cardiac failure, ischaemic heart disease Heart failure. and bradycardia. Tachycardia. -Sjogrene syndrome.Lethargy ,Anaemia. Diarrhoea. -Lassitude..  Diagnosis -Cretinism = congenital 7 Diagnosis hypothyroidism -Myxedema = (adult 8 Complications hypothyroidism) puffy face, slow heart rate… 9 Treatment -Grave’s disease = production of antibodies that mimic TSH à large thyroid  Diagnosis -Cretinism = congenital 7 Diagnosis hypothyroidism -Myxedema = (adult 8 Complications hypothyroidism) puffy face, slow heart rate… 9 Treatment -Grave’s disease = production of antibodies that mimic TSH à large thyroid  Diagnosis -HYPERTHYROIDISM Associated with: 7 Diagnosis Diffuse autoimmune goitre (Graves’s disease ). 8 Complications Multinodular goitre. Thyroiditis. 9 Treatment Thyroid hormone overdosage. Ectopic thyroid tissues.  HYPOTHYROIDISM HYPERTHYROIDISM Complications myxoedema coma Thyroid crisis: Can be precipitated in untreated cases of is a life-threatening complication of hyperthyroidism if subjected to pain, anxiety, hypothyroidism trauma, GA or premature cessation of Diagnosis antithyroid treatment. 4 Primary symptoms of myxedema coma The patient c/o tremor, dysapnoea, are altered mental status and low body hyperthermia and tachycardia (ventricular temperature. Low blood sugar, low febrillation ). 5 Complications blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation may also occur. 6 Treatment Complications  HYPOTHYROIDISM HYPERTHYROIDISM Thyroid crisis: Treatment by- -Treated by: Treated by daily oral thyroxine - Beta blockers( sudden stop potassium iodide, 7 Diagnosis sodium. can precipitate the thyroid propylthiouracil, crisis in 4 hours ). propranolol or Carbimazole and chlorpromazine propylthiouracil. 8 Complications Iodine. Surgery Treatment 9 Treatment  Hypothyrodism Hyperthyrodism dental management Dental management: Dental management: 10 dental management Precipitation of myxoedema coma by: -In untreated patients the sympathetic -Sedatives (midazolam and diazepams). overactivity may lead to fainting. -Opioids (codeine). -LA is the main way of pain control. 11 Oral/Orofacial manifestations -Tranquillizers. -Conscious sedation is desirable. LA is satisfactory for pain control. -Povidine iodine and similar compounds Conscious sedation can be carried out are best avoided. nitrous oxide and oxygen. -Carbimazole can cause agranulocytosis GA should be postponed until the (oral ulcers). initiation of thyroxine treatment. -Otherwise treated thyrotoxic patient present no special treatment in the dental treatment.  Lingual thyroid The thyroid normally develops as a down 10 dental management growth from the Oral/Orofacial foramen caecum at the 11 manifestations junction of the posterior third with the anterior two-thirds of the tongue  Rarely, ectopic thyroid tissue remains in this tract and may be seen as a lump 10 dental management in the midline between the 11 Oral/Orofacial foramen caecum and manifestations epiglottis, but has also been recorded in the oropharynx, infra-hyoid region, larynx.  Contue. Lingual thyroid common in females, Asymptomatic but may cause 10 dental management dysphagia, airway obstruction or even 11 Oral/Orofacial manifestations haemorrhage. Hypothyroidism (in about 1/3 of cases) Rarely transform into malignancy  Contue. Lingual thyroid 10 dental management The diagnosis: is confirmed by 11 Oral/Orofacial manifestations Iodine-123 or -131, or technetium-99 uptake in the tongue, Biopsy, MRI.  Contue. Lingual thyroid Treatment: Depends on the size of the lingual thyroid 10 dental management If normal functioning thyroid tissue is identified in the neck. 11 Oral/Orofacial manifestations Treatment modalities if there is indication: Surgery Radio iodine (iodine-131) if the patient is unfit Thyroxine may be needed