Term
| What are the 4 congenital pathologies of the thyroid? |
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Definition
| Aplasia, thyroglossal duct cyst, Aberrant thyroid and congenital goiter |
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Term
| T/F aplasia of the thyroid means that only some of the thyroid gland develops? |
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Definition
| F...it means that none of the thyroid gland develops |
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Term
| What are the 4 characteristics that a thyroglossal duct dyst must have in order to be diagnosed as such? |
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Definition
| single, midline, anterior to larynx and trachea and will elevate when the patient sticks their tongue out or swallows |
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Term
| Which two congenital pathologies of the thyroid are on the midline? |
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Definition
| thyroglossal duct cyst and aberrant thyroid |
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Term
| Which congenital pathology of the thyroid can have drainage from the base of tongue, can fistulate to skin surface and rarely becomes cancerous? |
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Definition
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Term
| Which congenital pathology of the thyroid is usually a problem during pregnany or puberty? |
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Definition
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Term
| Which congenital pathology of the thyroid is always in the posterior and may cause dysphagia? |
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Definition
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Term
| Which congenital pathology of the thyroid can become cancerous? |
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Definition
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Term
| Which congenital pathology of the thyroid produces hypothyroidism and swelling of the thyroid gland due to a negative feedback system? |
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Definition
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Term
| WHat are the 2 Autoimmune diseases of the thyroid? |
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Definition
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Term
| T/F Both Grave's and Hashimoto's disease is more common in females? |
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Definition
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Term
| What disease explains a thyroid becoming symmetrically swollen from an influx of lymphocytes? |
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Definition
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Term
| T/F A patient with Hashimoto's is unlikely to have other autoimmune diseases? |
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Definition
| F....there is particular autoimmune destruction of the adrenal cortex and stomach lining (causing chronic gastritis) |
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Term
| T/F Grave's dx causes hypothyroidism? |
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Definition
| F...Hashimotos causes hypothyroidism while Grave's cause hyperthyroidism |
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Term
| Which disease causes a thyroid gland to become larger due to hyperplasia of thyroid epithelium? |
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Definition
| Graves...and because of this thyroxin starts being produced more |
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Term
| T/F graves and hashimotos dx causes symmetrical enlargement of the thyroid? |
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Definition
|
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Term
| What is the largest goiter that we see in the thyroid? |
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Definition
| Nutritional nodular goiter |
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Term
| What is not there in a nodular goiter that should be in order to make thyroxin? |
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Definition
|
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Term
| T/F a nodular goiter can cause hypo or hyperthyroidism? |
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Definition
| T....If there is absolutely no iodine then hypo; if have a goiter and start getting enough iodine then hyper |
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Term
| T/F Broccoli, cauliflower, turnips, rutabaga, brussel sprouts and calcium can be bad for a person? |
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Definition
| T....if too much (I'm talkin' massive amounts) then the body destroys its ability to use iodine |
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Term
| What are the 5 tumors of the thyroid? |
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Definition
| Adenomas, papillary carcinoma, follicular carcinoma, and medullary carcinoma, anaplastic |
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Term
| T/F An adenoma is perfectly benign, well demarcated, encapsulated and has two version (hot vs cold)? |
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Definition
| True....a hot nodule produces thyroxin and the cold nodule does not produce thyroxin |
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Term
| What is the most common of the thyroid cancers? |
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Definition
|
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Term
| T/F papillary carcinoma is fast growing and most patients have a history of radiation to the neck and chest areas? |
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Definition
| F...the patients do have a history of neck and chest radiation but the carcinoma is slow growing |
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Term
| What kind of patients do you often see with follicular carcinoma? |
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Definition
| Usually those with long standing thyroid disease...particulary adenomatous goiters |
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Term
| Which thyroid carcinoma metastasizes through the blood? |
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Definition
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Term
| What carcinoma of the thyroid do you often see in the bone/jaw? |
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Definition
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Term
| Which thyroid carcinoma is from C-cells? |
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Definition
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Term
| Which carcinoma is found in association with MEN? |
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Definition
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Term
| If you see multiple mucosal neuromas what pathology of the thyroid are you most likely looking at? |
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Definition
| Medullary carcinoma because it is in association with MEN and that is where you would see all these little bumps on the oral cavity |
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Term
| What is a familial goiter of the thyroid? |
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Definition
| when one cannot make thyroxin due to enzyme deficiency and feedback TSH stimulation causes enlargement |
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Term
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Definition
| Systemic disease with excessive Fe++ storage that collects in endocrine and causes hypofunction |
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Term
| What is the fastest growing tumor of all tumors? |
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Definition
| Anaplastic tumor of the thyroid |
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Term
| Describe an anaplastic tumor of the thyroid? |
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Definition
| It envelopes everything in 2 weeks...this includes the SVC, aorta, esophagus, trachea and infiltrates lung |
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Term
| What are the 2 causes of hypothyroidism? |
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Definition
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Term
| What is cretinism caused by? |
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Definition
| aplasia, familial goiter and iodine deficiency |
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Term
| What are some of the results of cretinism? |
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Definition
| obese children, does not reach normal stature, skin is soft and doughy, mentall retarded, dry brittle hair and macroglossia |
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Term
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Definition
| the adult version of hypothyroidism, where the basal metabolism slows down, the person becomes mentally sluggish (but can come out of it with thyroxine treatments), heart flabby, overweight, doughy yellowish skin, course features, slow breathing, macroglossia and can't tolerate cold weather |
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Term
| T/F Hyperthyroidism is usually caused by hashimoto's dx? |
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Definition
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Term
| What are some of the complications of hyperthyroidism? |
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Definition
| increase cardiac output, malignant exopthalmus of graves, thyroid storm |
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Term
| What are some of the characteristics of hyperthyroidism? |
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Definition
| fast heart beat, fast breathing, warm skin, eat a lot but does not put on weight, warm temperature |
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Term
| What is the difference between hyperthyroidism and thyrotoxicosis? |
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Definition
| The T3 and T4 found in blood and tissues are derived from an overactive, hyperfunctional thyroid gland in hyperthyroidism while thyrotoxicosis is applied more broadly and includes ALL causes of excess thyroid hormone whether or not they are intrinsic or extrinsic |
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Term
| T/F Graves dx is seen in 75% of cases overall of thyrotoxicosis and 90% of cases in patients under age 45? |
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Definition
| F...All true except patient under 40 not 45 |
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Term
| T/F Graves dx is often accompanied by infiltrative ophthalmopathy and pretibial myxedema? |
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Definition
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|
Term
| What is the pathogenesis of Graves dx? |
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Definition
| The formation of autoantibodies that bind to the TSH receptor in thyroid cell membranes and stimulate the gland to hyperfunction. The TSH-R Ab are demonstrable in the plasma of about 80% of patients. |
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Term
| What are the 11 causes of hyperthyroidism according to Firiollo? |
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Definition
| Graves dx, Autonomous toxic adenomas, Subacute thyroiditis, Jodbasedow disease, Thyrotoxicosis factitia, Struma ovarii, TSH hypersecretion by the pituitary, Hashimotos thyroiditis, Metastatic functioning thyroid carcinoma, pregnancy and trophoblastic tumors and amiodarone |
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Term
| What does this describe: nodular neoplasms that produce T4 independent of TSH and be described as foci of autonomous adenomatous hyperfunction of the thyroid? |
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Definition
| Autonomous toxic adenomas |
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Term
| What are the 2 types of autonomous toxic adenomas? |
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Definition
| Toxic uninodular goiter and Toxic multinodular goiter |
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Term
| What kind of etiology does subacute thyroiditis usually have? |
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Definition
| Viral (coxsackie, mumps, or adenovirus) |
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Term
| What is a sudden sore throat or neck pain usually indicative of? |
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Definition
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Term
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Definition
| Cause of hyperthyroidism that may occur in patients with multinodular goiters after intake of large amounts of iodine |
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Term
| This cause of hyperthyroidism usually results from overdose of thyroid hormone that sometimes can come from ground beef contaminated with bovine thyroid gland. |
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Definition
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Term
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Definition
| Cause of hyperthyroidosis in which thyroid tissue is contained in an ovarian dermoid tumor or teratoma and can secrete thyroid hormone |
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Term
| How does Hashimotos cause hyperthyrodism? |
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Definition
| May cause transient hyperthyroidism during the initial destructive phase while causing hypothyroidism in final stages |
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Term
| What is silent thyroiditis? |
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Definition
| most common in women and in postpartum period; characterized by a variable but mild degree of thyroid enlargement and followed by hypothyroidism |
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|
Term
|
Definition
| A drug used for chronic treatment of cardiac arrhythmias, which causes symptomatic hyperthyroidism in about 2.5% of patients |
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Term
| What are the T3, T4, TSH and RIU in conventional hyperthyroidism? |
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Definition
| T3: >200; T4: >12.5; TSH: below normal (<3.0) and RIU is elevated in Grave's dx and elevated or normal in toxic nodules |
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Term
| T/F Other laboratory abnormalities for hyperthyroidism may include: hypercalcemia, increased alkaline phosphatiase , anemia and increased granulocytes? |
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Definition
| F....all are true except increased granulocytes should be decreased granulocytes |
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Term
| T/F RIU is used to diagnose those with hyperthyroidism? |
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Definition
| F....RIU is used on patients with an established diagnosis of thyrotoxicosis. |
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Term
| When do you see a low RIU? |
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Definition
| In subacute thyroiditis...while you see elevated or normal in graves dx and toxic nodules |
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Term
| What are the 3 pharmacological treatments used for hyperthyroidism? |
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Definition
| B-adrenergic antagonists (for symptomatic relief), thiourea (PTU to inhibit the synthesis of thyroid hormones; used for mild cases and has little evidence of hypothyroidism after-effects), Radioactive sodium iodine (used to destroy overactive thyroid but has an increase incidence in hypothyroidism) |
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Term
| T/F surgery is indicated for younger patients with hashimotos whose disease has recurred after courses of antithyroid drug and refuse I therapy, in patients who cannot tolerate other drugs because of hypersensitivity or other problems, in patients with very large goiters, and in some younger patients with toxic adenomas. |
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Definition
| F...all is true except should be Graves' dx not hashimotos |
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Term
| T/F Postoperative recurrences of hyperthyroidism occur between 2 and 9%? |
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Definition
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|
Term
| What are the 3 main categories of complications of hyperthyroidism? |
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Definition
| Ocular, Cardiac, Thyrotoxic crisis (thyroid storm) |
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Term
| T/F Periodic paralysis and hypokalemia following exercise or carb ingestion may rarely complicate hyerthyroidism? |
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Definition
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Term
| What are the 2 cardiac complication of hyperthyroidism? |
|
Definition
| sinus tachycardia and atrial fibrillation |
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Term
| T/F Approximately 20% of thyroid storms end in death? |
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Definition
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|
Term
| What are the symptoms of a thyroid storm? |
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Definition
| fever, restlessness, tachycardia, atrial fibrillation, pulmonary edema, tremor, sweating, stupor, coma and death |
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Term
| T/F A thryoid storm is usually followed by physiological stress (usually infection, surgery, trauma, emotional stress, CV dx, systemic illness, diabetic ketoacidosis and vigorous palpation of the thyroid)? |
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Definition
| False....these usually precipitate the thyroid storm |
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Term
| What are the 6 oral findings associated with hyperthyroidism? |
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Definition
| increased susceptibility to caries, accelerated periodontal dx, enlargement of extraglandular thyroid tissue, osteoporosis, accelerated dental eruption and burning mouth syndrome |
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Term
| What are the 3 main reasons that untreated hyperthyroid patients have a significant risk for treatment? |
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Definition
the increased risk of thyroid storm precipitated via stress, acure oral infection, or vigorous gland palpatation;
Possible concurrent, secondary CV dx;
the possible adverse effect of using locals containing catecholamines |
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Term
| Dental treatment should be deferred if a hyperthryoid patient presents with what 3 characteristics? |
|
Definition
1. Symptoms of undiagnosed or uncontrolled hyperthyroidism including tachycardia, irregular pulse, sweating, hypertension, tremor
2.) an unreliable or vague hx of thyroid dx and management
3.) neglect to follow physician-initiated control of thyroid dx for more than 6-12 months, and would require appropriate med referral |
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Term
| What is the risk and ASA classification for the following: asymptomatic patients with physical and thyroid finction tests within normal limits (within past 6 months) |
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Definition
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Term
| What is the risk and ASA classification for the following: Asymptomatic patients with no recent physical or thyroid function tests |
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Definition
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Term
| What is the risk and ASA classification for the following: Patients with symptoms and/or current abnormal thyroid function tests |
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Definition
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Term
| T/F Agranulocytosis is an uncommon but serious complication of B-blockers being reported in about 0.1% of patients taking methimazole and 0.4% in patients taking PTU? |
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Definition
| F....which should be obvious because the 2 drugs mentioned are thiourea antithyroid drugs not B-blockers therefore all of it is true except B-blockers should be thiourear drugs |
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Term
| T/F Nitrous should not be used in patients with hyperthyroidism? |
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Definition
| F...you should use it because it reduces stress and stress can precipitate a thyroid storm |
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Term
| T/F Local anasthetics containging vasoconstrictors should be used with caution in patients with non-medically treated or uncontrolled hyperthyroidism as well as those taking non-cardioselective B-blockers |
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Definition
| T....some patients wth excessive thryroid hormone in circulation will have developed cardiac abnormalities as a result of chronic overstimulation of myocardial metabolism |
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|
Term
| What are the steps you should take if a thyroid storm occurs? |
|
Definition
1.) Before anything activate EMS!!!
2.)Treat hyperexia with acetaminophen (NOT aspirin)
3.)CHF managed with oxygen
4.)IV fluid replacement
5.)Corticosteroids
6.)Monitor vital signs |
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|
Term
| T/F hypothyroidism is a clinical state resulting from decreased circulating levels of free thyroid hormone or from resistance to hormone action. (If myxedema present then it is considered severe). |
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Definition
|
|
Term
| What is primary vs secondary vs tertiary hypothyroidism? |
|
Definition
| Primary is caused by thyroid gland failure and secondary is produced by failure of the pituitary or hypothalamus in which the defect is a deficiency of TSH and tertiary is due to hypothalamic failure because TRH deficiency causes inadequate TSH secretion from otherwise finctional thyrotroph cell of the anterior pituitary |
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|
Term
| What are the 4 basic causes of primary hypothyroidism? |
|
Definition
1. Autoimmune
2. Postablative
3. Goitrous
4. Non-autoimmune |
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|
Term
| T/F Autoimmune hypothyroidism is often associated with other autoimmune disease of the endocrine system, including autoimmune hypoparathyroidism, adrenal failure, hypogonadism and type 1 diabetes? |
|
Definition
|
|
Term
| Postablative hypothyroidism is usually foud after what kind of treatment of hyperthyroidism? |
|
Definition
| Radioactive iodine 131 treatment or surgery |
|
|
Term
| WHy does a goitrous hypothyroidism occur? |
|
Definition
| Because of decreased ability of the thyroid gland to synthesize thyroid hormone...which leads to increased TSH secretion which then results in increase of thyroid size; can also be due to drugs and genetic defects |
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Term
| What are the 2 types of primary non-autoimmune hypothyrodism? |
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Definition
| Riedel's thyroiditis and Subacute thyroiditis |
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|
Term
| T/F symptoms of uncontrolled hypothyroid patients includes: weakness, lethargy, heat intolerance, increased sweating, decreased memory, constipation, modest weight gain, dyspnea, hoarseness, anorexia, menorrhagia, hearing impairment, muscle cramps, arthralgias, paresthesias, depression, carpal tunnel syndrome? |
|
Definition
| F...all except heat intolerance and increased sweating should be cold intolerance and decreased sweating....heat and increased are characteristic of hyperthyroidism |
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|
Term
| What is the primary test used in diagnosis of hypothyodism? |
|
Definition
|
|
Term
| What are some other la abnormalities that you see with hypothyroidism? |
|
Definition
| increased serum cholesterol, liver enzymes and CPK; increased serum prolactinl hyponatremia; hypoglycemial and anemia |
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|
Term
| What is the treatment of choice for hypothyroidism? |
|
Definition
| Levothyroxine.....this must be continued for life...T4 levels are seen within 1-2 weeks and near max levels in 3-4 weeks; while TSH will drop back to normal when start T4 |
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Term
| T/F A Myxedema coma is similar to a thyroid storm? |
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Definition
| F...it is the opposite; patients have severe manifestations of hypothyroidism (bradycardia and severe hypotension) as well as impaired mentation; hypothermia, hyponatremia and hypoglycemia. |
|
|
Term
| How do you treat a myxedematous coma? |
|
Definition
| Stress dosages of corticosteroids, monitor serum glucose, warmed with blankets; if hpercapnic then require intubation; infection treated aggressively and levothyroxine sodium 400 ug given IV as a loading dose followed by 100 ug daily |
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|
Term
| Oral findings of hypothyroidism include: |
|
Definition
| macroglssia, dysgeusia, delayed eruption of teeth, poor perio health, delayed wound healing |
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|
Term
| Dental treatment should be deferred in hypothyroid patients with:??? |
|
Definition
-an unreliable or vague hx of thyroid dx and management
-neglect to follow physician-initiated control of thyroid dx for more than 6-12 months
-signs and symptoms of undiagnosed or persistent hypothyroidism, and would require appropriate medical referral |
|
|
Term
| What are the steps for a myxedematous coma? |
|
Definition
1. Call EMS
2. hydrocortisone; oxygen mask
3. monitor vital signs |
|
|
Term
| Look over all the dental treatment considerations for hypothyroidism |
|
Definition
| Okay...seriously do it now |
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