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Medically Compromised Patients Supporting Your Practice

Treating Patients with Thyroid Disease

Dr. Aviv Ouanounou comes back to speak about how to manage patients who suffer from thyroid disease. 


Dr. Aviv Ouanounou discusses thyroid disease and its dental implications. The thyroid gland produces two important thyroid hormones, T4 (thyroxine) and T3 (triiodothyronine). The thyroid gland has many important functions including: metabolism, growth and development, cardiovascular effects (stroke volume, heart rate etc.), memory, growth and maturation of the epidermis and the central nervous system. Thyroid disease commonly presents as either hypothyroidism or hyperthyroidism and commonly affects women more often than men.

Risk factors for thyroid disease include women aged 55+, obesity, radiation to the thyroid gland or head and neck region, as well removal of the thyroid gland.

Common oral manifestations seen in hypothyroidism may include salivary gland enlargement, macroglossia, glossitis, delayed dental eruption, compromised periodontal health and dysgeusia. In hyperthyroidism, patients may be predisposed to periodontal disease, an increased risk of caries, accelerated dental eruption and a burning tongue sensation.

Potential Adverse Drug Interactions:

Hypothyroidism and the use of levothyroxine

  • Impaired absorption of levothyroxine with use of iron supplements, aluminum dihydroxide
  • Increased metabolism of levothyroxine with the use of dilantin, carbamazepine
  • Levothyroxine may increase the action of warfarin
  • Increased sensitivity to barbiturates
  • Potential adverse drug reactions with local anesthetics containing epinephrine and levothyroxine

Hyperthyroidism Medications

  • Can cause abnormal cytosis, leukopenia with increased bleeding
  • They can interact with aspirin, NSAIDs, oral contraceptives and estrogen supplements

Dental Management:

  • Establish which thyroid condition the patient is afflicted with and how it is managed and how well
  • May want to have a CBC to evaluate whether the patient is leukopenic
  • Defer elective treatment depending upon the cardiovascular health of the patient and apply the cardiovascular protocol (monitor BP etc.)
  • Oral examination should include monitoring and palpation of the salivary glands
  • Consultation with the MD may be necessary



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