Hyperthyroidism (Graves Disease) Fact Sheet

Dan Boboia, DDS

What is it?

A hypermetabolic state that results from excess synthesis and release of thyroid hormone from the thyroid gland. This comes as a result of a disruption of the homeostatic mechanisms that normally adjust hormone secretion to meet the needs of peripheral tissues.

Epidemiology

0.5 – 1% in general population

95% of all cases in children are due to Graves Disease

Majority of cases occur during adolescence

Etiology

The cause is unknown; it results from the presence in plasma of an abnormal thyroid stimulator called the long acting thyroid stimulator or LATS; an immunoglobulin or family of immunoglobulins directed against the TSH receptor mediates thyroid over-stimulation

Graves Disease

• Most common form of hyperthyroidism
• Thyroid gland over activity
• Autoimmune disease
• 5 x more common among women than men
• Associated with eye disease (Graves opthalmia) and skin lesions (dermopathy)

**Graves opthalmia is a condition caused by inflammatory / fatty infiltrate of the orbital content resulting in a protrusion of the globe; creates a "frightened look".

**Dermopathy is a thickened layer of dermis observed over the dorsum of the legs and feet.

Hyperthyroidism

• XS intake of thyroid hormones
• Pituitary gland tumor (xs TSH secretion)
• Adenoma: masses of thyroid cells which will trap xs iodine producing xs thyroid hormones; 90% are benign
• Toxic Multinodular Goiter: also known as Plummers Disease; multiple masses of overactive thyroid glandular tissue
• Thyroiditis: inflammed thyroid
• XS Iodine intake
• Metastatic thyroid cancer

Complications / Signs / Symptoms

• Osteoporosis
• Atrial fibrillation
• Hypertension
• CHF

Thyrotoxic crisis / Thyroid Storm

• Extreme restlessness, nausea, vomiting, abdominal pain
• Fever, profuse sweating, tachycardia, cardiac arrhythmias, pulmonary edema,
• Stupor, coma
• Severe hypotension
• Death

Diagnosis

• Symptoms: rapid heart rate, intense fatigue, inability to tolerate a hot environment, irritability, nervousness
• Physical signs: weight loss, tachycardia, hand tremors, xs sweating
• Blood Tests: high levels T3 and T4 low level of circulating TSH
• Diagnostic scan: RAIU—radioactive iodine uptake test

Medical Treatment

• Antithyroid drugs: propylthiouracil, methimazole, carbimazole
• Radioactive Iodine (I-131): often results in hypothyroidism
• Thyroidectomy

Oral Findings

• Osteoporosis involving alveolar bone
• Dental caries and periodontal disease appear more rapidly in these patients
• Teeth and jaws develop more rapidly
• Premature loss of deciduous teeth with early eruption of permanent teeth
• Euthyroid infants of hyperthyroid mothers have been reported with erupted teeth at birth
• Damaged salivary gland (secondary to radioactive iodine)