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• Thyroid glands secrete tri-iodothyronine (T3) and thyroxine (T4). They stimulate
metabolism as they act on all the cells of the body by increasing the rate at which
food is used up and converted into heat and energy.
The thyroid gland secretion is under the control of pituitary glands which secrete
TSH. The release of TSH from pituitary gland is regulated by thyrotropin-releasing
factor (TRF) from hypothalamus.
• Negative feed back mechanism similar to the pituitary adrenal axis is also
regulating the thyroid gland secretion and the axis is called pituitary thyroid axis.
• The precise role of thyroid hormones is not known. However, excessive secretion
increases the basal metabolic rate (BMR).
Disorders of thyroid gland:
(1) Hypothyroidism:
- Etiology: the circulating level of thyroxine in the blood will fall, and there will be
a reduction in the body's metabolism. In a child, this reduction in metabolism will
slow the developmental processes leading to a stunted, mentally retarded dwarf
The clinical symptoms vary depending on the age at which the deficiency
develops:
a- In childhood (Cretinism):
- There is delayed physical, sexual and mental development, with
disproportionate body organs and abdominal protuberance.
- Delayed walking, talking and idiot infant.
- Skin: is dry and coarse and wrinkled.
- Nose: Is depressed, wide nostrils.
Oral manifestations:
• Delayed eruption of teeth. • Micrognathia.
• Macroglossia, protruded tongue, with partially opened mouth.
• Malocclusion, anterior open bite. • Puffy, enlarged, protruded lip.
b- In adults (myxedema):
Clinical manifestation:
- There is the deposition of semi-fluid material under the skin that gives the name
to this condition (myxa (Greek) = mucus; oidema = swelling).
- The skin becomes rough and coarse.
- The hair thins on the eyebrows and scalp, brittle nails and decreased sweating.
- The face and eyelids become puffy
- ▼ basal metabolic rate and body temperature, cold intolerance (hypothermia).
- The heart rate is slower: (bradycardia) and hypotension.
- Loss of appetite.
- Depressed mental functions: Crazy, Apathetic, less response to stimuli., loss of
concentration.
Management:
- Call ambulance for hospitalization.
- Artificial respiration.
- 200 mg hydrocortisone i.v.
Dental precautions:
• Myxedema coma:
Precipitating factor:
• Trauma, surgery, infection, GA.
• Sedative (diazepam), analgesic (codeine). The respiratory centre is
hypersensitive to these drugs, they should be avoided or the dose must be
reduced.