Medical ConditionsEndocrine, GI & renal: Hyperthyroidism
Medical ConditionsEndocrine, GI & renal: Hyperthyroidism
Hyperthyroidism
Overview
Board takeaway: Defer elective treatment for uncontrolled thyrotoxicosis and coordinate medical stabilization; recognize thyroid storm as an emergency.
What causes hyperthyroidism in children?
Graves disease causes autoimmune stimulation of thyroid hormone production and is the predominant pediatric cause. Autonomous thyroid tissue is less common. Thyroiditis or excess replacement can produce thyrotoxicosis through mechanisms other than increased gland synthesis.
Which findings suggest hyperthyroidism?
Tachycardia, palpitations, tremor, heat intolerance, sweating, sleep or attention problems, and weight loss or poor weight gain despite appetite may occur. Goiter is possible. Graves-related eye disease may produce proptosis. Increased growth or bone maturation and cardiovascular effects require medical assessment.
What oral findings are reported in hyperthyroidism?
Accelerated eruption, altered bone turnover, and oral discomfort or dryness are reported. Caries and periodontal status still need individual assessment. Radioactive iodine treatment can affect salivary function in some patients. No oral finding alone confirms thyroid hormone excess.
How should dental treatment be planned for hyperthyroidism?
Confirm treatment and current control. Stable, controlled disease generally permits routine care. Defer elective treatment in untreated or poorly controlled thyrotoxicosis; adrenergic stress and vasoconstrictors can worsen cardiovascular effects. Coordinate urgent dental needs with endocrinology and anesthesia when relevant. Review antithyroid-drug adverse effects: fever or sore throat while taking these drugs warrants prompt medical assessment for possible agranulocytosis.
What should happen if thyroid storm is suspected during dental care?
Stop treatment and activate emergency medical services for severe fever with marked tachycardia or arrhythmia, agitation or altered consciousness, and systemic deterioration. Assess airway, breathing, and circulation and provide supportive emergency care. Definitive antithyroid and cardiovascular treatment belongs in medical emergency care; do not delay transfer to complete a dental drug regimen.
What treatment and prognosis apply to hyperthyroidism?
Medical treatment may include antithyroid medication, symptom control with a beta blocker, or selected definitive therapy. Treatment choice differs by age and cause. Prognosis is generally favorable with control; recurrent disease and treatment-induced hypothyroidism require follow-up.