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Medically Compromised Patient Care

Course Number: 628

Thyroid Disorders

The two main type of thyroid disorders hyperthyroid and hypothyroid. Hyperthyroid occurs when there are elevated levels of T4 and T3 and low or undetectable TSH levels. The disease is often associated with an autoimmune disorder, called Grave’s Disease. The most common medical emergency seen in patients with hyperthyroid is a thyroid storm, which includes rapid pulse, fever and even fainting.22 Modifications to dental treatment depend on whether the patient’s hyperthyroidism is controlled or uncontrolled. If it is uncontrolled, no treatment should be performed. A medical consult is indicated for uncontrolled hyperthyroid patients and they must not be given any epinephrine. If the patient is controlled, nitrous oxide administration is ok and no premedication is necessary. Patients with controlled hyperthyroid can receive a cardiac dose of epinephrine.

Hypothyroid is characterized by decreased levels of T4 and T3 and increased TSH levels. Symptoms include cold intolerance, fatigue, weight gain, and diffuse goiter. It is often associated with the autoimmune disease Hashimoto’s Thyroiditis. The medical emergency that can occur in hypothyroid patients is called myxedema coma, which has hallmark symptoms of lethargy, confusion, weakness, and breathing difficulties. 23 When planning dental treatment for patients with hypothyroidism, nitrous oxide and local anesthetic with vasoconstrictor are ok when a cardiac dose is used. No premedication is necessary and a medical consult is only needed if the condition is undiagnosed or uncontrolled.