A Practical Approach to Special Care in Dentistry. Группа авторов

periodic paralysis (attacks of mild to severe weakness)

       Thyrotoxic crisis/thyroid stormA severe condition that starts with extreme anxiety, nausea, vomiting and abdominal painLater, it is associated with fever, sweating, tachycardia and pulmonary oedemaFinally, stupor, coma and possibly deathTable 5.3.2 Causes of hyperthyroidism.CategoryCausesPrimaryIncreased stimulation secondary to:Thyroid‐stimulating hormone receptor antibodies (TRAb), seen mostly in Graves diseaseExcess human chorionic gonadotropin (hCG) secretion in patients with hyperemesis gravidarumTrophoblastic tumours such as choriocarcinoma or hydatidiform moleAutonomous thyroid functionToxic multinodular goitreSolitary toxic noduleFamilial non‐autoimmune hyperthyroidismExcess release of stored thyroid hormoneAutoimmune (silent or postpartum thyroiditis)Infective (viral, bacterial, fungal)Pharmacological (amiodarone, interferon‐alpha)Exposure to excess iodineExcess iodine intake during radiographic contrastConsumption of high quantities of iodine‐rich foods (e.g. fish, seaweed, egg yolks)/supplements/medications containing iodine (amiodarone)SecondaryInappropriate thyroid‐stimulating hormone (TSH) secretionTSH‐secreting pituitary adenomaPituitary resistant to thyroid hormoneExtrathyroidExcess intake of thyroid hormoneIatrogenic/factitiousEctopic thyroid hormone secretionStruma ovariiFunctional thyroid metastases

      Management

       Symptom control with beta‐blockers such as propranolol or nadolol may be used in the first few weeks after diagnosis

       Treatment of hyperthyroidismAntithyroid drugs – carbimazole, propylthiouracil and methimazole; the course of treatment lasts 18 months; 30–50% chance of cureRadioactive iodine – very effective/safe; treatment results in hypothyroidism with the need to take levothyroxine long‐termSurgery – considered for younger patients with large goitres and for those in whom antithyroid drugs are not effective; again results in hypothyroidism with the need to take levothyroxine long‐term; potential risk to laryngeal nerve

      Prognosis

       The severity of hyperthyroidism depends on the amount and duration of hormone excess, age and complications

       Thyrotoxic crisis or thyroid storm may lead to coma and occasionally death

      A World/Transcultural View

       Hyperthyroidism is a common condition with potentially life‐threatening health consequences that affects all populations worldwide. In advanced economies, the prevalence of undiagnosed thyroid disease is falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation

       Iodine nutrition remains a key determinant of thyroid function worldwide. More studies are needed in developing countries, especially within Africa, to understand the role of ethnicity and iodine nutrition fluxes in current disease trends

Recommended Reading

      1 Bahn, R.S., Burch, H.B., Cooper, D.S. et al. (2011). American Thyroid Association, American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 21: 593–646.

      2 Biron, C.R. (1996). Patients with thyroid dysfunctions require risk management before dental procedures. RDH 16: 42–44.

      3 Gortzak, R.A. and Asscheman, H. (1996). Hyperthyroidism and dental treatment. Ned. Tijdschr. Tandheelkd. 103: 511–513.

      4 Lee, K.J., Park, W., Pang, N.S. et al. (2016). Management of hyperthyroid patients in dental emergencies: a case report. J. Dent. Anesth. Pain Med. 16: 147–150.

      5 Sundaresh, V., Brito, J.P., Wang, Z. et al. (2013). Comparative effectiveness of therapies for Graves' hyperthyroidism: a systematic review and network meta‐analysis. J. Clin. Endocrinol. Metab. 98: 3671–3677.

      6 Taylor, P., Albrecht, D., Scholz, A. et al. (2018). 2018 global epidemiology of hyperthyroidism and hypothyroidism. Nat. Rev. Endocrinol. 14: 301–316.