RISK STARTIFICATION AND RISK STARTIFICATION AND DENTAL MANAGEMENT OF DENTAL MANAGEMENT OF PATIENTS WITH THYROID PATIENTS WITH THYROID DYSFUNCTION DYSFUNCTION Géza T. Terézhalmy, D.D.S., M.A. Géza T. Terézhalmy, D.D.S., M.A. Professor and Dean Emeritus School Professor and Dean Emeritus School of Dental Medicine Cleveland, Ohio of Dental Medicine Cleveland, Ohio [email protected][email protected]
52
Embed
RISK STARTIFICATION AND DENTAL MANAGEMENT OF PATIENTS WITH ...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
RISK STARTIFICATION RISK STARTIFICATION AND DENTAL AND DENTAL
MANAGEMENT OF MANAGEMENT OF PATIENTS WITH THYROID PATIENTS WITH THYROID
DYSFUNCTIONDYSFUNCTION
Géza T. Terézhalmy, D.D.S., M.A. Géza T. Terézhalmy, D.D.S., M.A. Professor and Dean Emeritus Professor and Dean Emeritus
School of Dental Medicine School of Dental Medicine Cleveland, Ohio Cleveland, Ohio
» 85% is due to sporadic thyroid dysgenesis» 15% due to autosomal recessive mode of
inheritance– Recognized cause of mental retardation
» Symptoms begin to appear at about the 3rd month of life (cretinism)
Terezhalmy 1104/12/23
Thyroid DysfunctionThyroid Dysfunction
• Clinical manifestations– Hypothyroidism
• Congenital– Cretinism
» Puffy face» Large cranium» Flat and broad nose» Macroglossia» Thick elevated lips» Open mouth» Altered calcification of teeth» Delayed eruption of teeth
Terezhalmy 1204/12/23
Thyroid DysfunctionThyroid Dysfunction
• Clinical manifestations– Hypothyroidism
• Primary – Chronic
autoimmune thyroiditis
– Iatrogenic (surgery, 131I-therapy)
– Diffuse and nodular goiter
– Severe iodine deficiency
Terezhalmy 1304/12/23
Thyroid DysfunctionThyroid Dysfunction
• Clinical manifestations– Hypothyroidism
• Secondary– Pituitary
Terezhalmy 1404/12/23
Thyroid DysfunctionThyroid Dysfunction
• Clinical manifestations– Hypothyroidism
• Tertiary– Hypothalamic
Terezhalmy 1504/12/23
Thyroid DysfunctionThyroid Dysfunction
• Clinical manifestations– Hypothyroidism
• Clear female predominance (5-10:1)– 10 million in U.S. (8 million undiagnosed)
• Myxedema– Slow speech– Lethargy – Mental impairment– Depression– Increased sensitivity to cold– Pitting edema– Reduced rate of respiration
Inhibits the transformation of inorganic iodine to organic iodineANDBlocks the conversion of T4 to T3
Long-term thyroxin suppressionORIn preparation for surgery or radioiodine therapy
AgranulocytosisHepatotoxicityUrticariaArthralgia
Terezhalmy 3704/12/23
Thyroid DysfunctionThyroid Dysfunction
Drug Mechanisms of action Indication ADEs
IodineORIodide
Short-term inhibition of thyroxine release
Adjunctive therapy to antithyroid drugs OR In preparation for surgery
Allergic reactions
Terezhalmy 3804/12/23
Thyroid DysfunctionThyroid Dysfunction
DENTAL MANAGEMENT
CONSIDERATIONS
Terezhalmy 3904/12/23
Thyroid DysfunctionThyroid Dysfunction
• Goals– Develop and
implement timely preventive and therapeutic strategies compatible with the patients’ physical and emotional ability to undergo and respond to dental care
• Medical history– Review of organ
systems– Drug History
Terezhalmy 4004/12/23
Thyroid DysfunctionThyroid Dysfunction
• Functional capacity– T3 exerts direct
inotropic and chronotropic effects on cardiac muscle
– T3 is synergistic with epinephrine
– Metabolic equivalents (METs)• Ability of the CV
system to meet metabolic demand for oxygen– Poor functional
capacity» < 4 METs
Terezhalmy 4104/12/23
Thyroid DysfunctionThyroid Dysfunction
• Vital signs– Blood pressure
• < 180/110 mm Hg– Not an
independent risk factor for cardiovascular risk in association with non-cardiac procedures
• > 180/110 mm Hg constitutes a medical emergency
• < 90/50 mm Hg reliable sign of shock
– Pulse pressure, rate, and rhythm• Pulse pressure
correlates closely with systolic BP– Reliable
cofactor to either rule out or confirm significant CVD
• Pulse rate – <50 or >100
beats/min constitutes a medical emergency
Terezhalmy 4204/12/23
Thyroid DysfunctionThyroid Dysfunction
• Treatment strategies– The physiological
events associated with the thyroid dysfunction and the “stress” of a procedure can affect cardiac function (myocardial ischemia)