Hyperthyroidism and dental treatment protocol

 Hyperthyroidism and dental treatment protocol

Increase secretion of thyroid hormones (T3, T4) in

the circulation that can lead to thyroid crisis

 Signs and symptoms of thyrotoxicosis:

1. Increased apatite and loss of weight

2. Warm moist skin

3. Irritability and nervousness

4. Fine tremors and muscle weakness

5. Increased cardiac output, pulse rate and blood pressure

6. Tachycardia

7. Dyspnea on exertion

8. Exophtalmous

Dental Management Considerations (Prevention of

thyroid crisis) :

1. Medical Consultation

2. Postpone surgery until thyroid dysfunction is well

controlled (1-2 months after controlling the case)

3. Stress reduction protocol

4. Avoid the use of vasoconstrictor

i. Use plain anesthesia

ii. Use local anesthesia with vasoconstrictor other than Adrenaline / Noradrenaline

5. Avoid Atropine as it may lead to thyroid crisis

Thyroid Crisis

Thyroid storm is an emergency condition associated with untreated hyperthyroidism, and is caused by a hypermetabolic state. 

 Early symptoms of thyroid crisis

1. Restlessness

2. Nausea

3. Abdominal cramps

 Late symptoms of thyroid crisis

1. High fever

2. Tachycardia

3. High pulse rate with severe hypotension

4. Tachypnea due to pulmonary oedema

5. Coma and heart failure

 Management of thyroid crisis:

1. Urgent call for medical aid

2. Cold packs to decrease temperature

3. Oxygen

4. Cardiopulmonary resuscitation

5. 100-300 mg hydrocortisone IV

6. Anti-thyroid medications e.g. potassium iodide or

200 mg propranolol

7. IV fluid as a supportive measures