Medical ConditionsEndocrine, GI & renal: Hypothyroidism
Medical ConditionsEndocrine, GI & renal: Hypothyroidism
Hypothyroidism
Overview
Board takeaway: Confirm control before elective care; severe untreated hypothyroidism increases procedural and sedative risk.
What causes hypothyroidism in children?
Congenital disease may reflect an absent, ectopic, underdeveloped, or poorly functioning thyroid. Acquired disease commonly includes autoimmune Hashimoto thyroiditis; medications, surgery, radiation, iodine imbalance, or central endocrine disease are other causes. Primary hypothyroidism typically produces low free thyroxine with elevated thyroid-stimulating hormone, but central disease has a different laboratory pattern.
Which systemic findings characterize hypothyroidism?
Fatigue, cold intolerance, constipation, dry skin, slowed heart rate, and reduced growth velocity may occur. Weight gain can accompany slowed growth. Untreated congenital disease can impair neurodevelopment, making newborn screening and prompt treatment important. Severe untreated disease can rarely cause myxedema coma.
What oral findings are reported in hypothyroidism?
Delayed eruption, macroglossia, altered jaw growth, crowding or other malocclusion, enamel-development defects, and dry mouth are reported. Puffy facial tissues or thick lips may occur in more pronounced disease. These are associations, not diagnostic criteria; assess other causes of delayed development.
How should dental treatment be planned for hypothyroidism?
Well-controlled disease usually permits routine dental care. Suspected or poorly controlled disease requires medical assessment before elective procedures. For substantial disease, coordinate cardiovascular status, airway concerns, and sensitivity to sedatives or opioids with the treating clinician and anesthesia team. Do not infer a bleeding disorder solely from the diagnosis; assess history and actual findings. Radiographs follow clinical need and current radiation guidance rather than a thyroid-specific routine schedule.
How is hypothyroidism treated and what is the prognosis?
Levothyroxine replaces thyroid hormone, with dosing and monitoring directed by the medical team. Early treatment of congenital disease prevents major avoidable developmental injury. Many patients require lifelong therapy and have a good outlook when appropriately treated. Hypothermia, marked lethargy, hypoventilation, or altered responsiveness in severe disease requires emergency care.