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Congenital Hypothyrodism and Its Oral Manifestations Hipotiroidismo Congénito Y Sus Manifestaciones Bucales

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Congenital Hypothyrodism and Its Oral Manifestations Hipotiroidismo Congénito Y Sus Manifestaciones Bucales www.medigraphic.org.mx Revista Odontológica Mexicana Facultad de Odontología Vol. 18, No. 2 April-June 2014 pp 133-138 CASE REPORT Congenital hypothyrodism and its oral manifestations Hipotiroidismo congénito y sus manifestaciones bucales Marxy E Reynoso Rodríguez,* María A Monter García,§ Ignacio Sánchez FloresII ABSTRACT RESUMEN Hypothyroidism is one of the most common thyroid disorders. El hipotiroidismo es el más común de los trastornos de la tiroides, Hypothyroidism can be congenital in cases when the thyroid puede ser congénito si la glándula tiroides no se desarrolla correc- gland does not develop normally. Female predominance is a tamente (hipotiroidismo congénito). La predominancia femenina es characteristic of congenital hypothyroidism. Dental characteristics una característica. Entre las características odontológicas del hi- of hypothyroidism are thick lips, a large-sized tongue which, due potiroidismo se observan labios gruesos, lengua de gran tamaño, to its position, can elicit anterior open bite as well as fanned-out que debido a su posición suele producir mordida abierta anterior y anterior teeth. In these cases, delayed eruption of primary and dientes anteriores en abanico, destaca que la dentición temporal y permanent dentitions can be observed, and teeth, even though permanente presentan un retardo eruptivo característico y, aunque normal-sized, are crowded due to the small-sized jaws. This study los dientes son de tamaño normal, suelen estar apiñados por el ta- presents clinical cases of female patients diagnosed with congenital maño pequeño de los maxilares. Se presentan dos casos clínicos hypothyroidism who sought treatment at the Dental Pediatrics Unit de pacientes de sexo femenino que acuden a la clínica de Especia- of the Autonomous University of the State of Mexico. lidad en Odontopediatría de la Universidad Autónoma del Estado de México con diagnóstico de hipotiroidismo congénito. Key words: Hypothyroidism, myxedema, cretinism, delayed eruption, macroglossia, paedodontics. Palabras clave: Hipotiroidismo, mixedema, cretinismo, erupción tardía, macroglosia, odontopediatría. INTRODUCTION another condition can indirectly cause decrease in the hormone circulation (for example, a surgical event or a The thyroid gland is located in the front section pathological alteration of the hypothalamus).9-11 of the neck, underneath the larynx. It produces two Some signs of hypothyroidism are, among many hormones: triiodo-thryronine (T3) and thyroxine (T4), others, the following: tiredness, mental depression, whose function is to control metabolism.1-5 weakness, skin and hair dryness. Notwithstanding, Alterations of the thyroid function are the most many patients afflicted with hypothyroidism can common cause of endocrine disease. They affect present only one or two symptoms. Hypothyroidism patients of all ages and present great variety of clinical can be congenital (CHT) in cases where the thyroid pictures. The spectrum varies from asymptomatic gland fails to develop correctly.1-4,9,13,14 situations, multi-systemic failures, neoplasia and, in certain cases, even death.2,6-8 Hypothyroidism is the most common thyroid disorder. In these cases, a thyroid hormone insufficiency is present. It is morewww.medigraphic.org.mx frequently found in women, increases with age and exhibits familial * Specialist in Pediatric Dentistry. Graduate in Pedodontics. § Specialist in Pediatric Stomatology. Pedodontics Undergraduate 1,3-5,8 tendency. and Graduate Professor, School of Dentistry. When hypothyroidism is present in childhood, it II PhD in Health Sciences. Professor at the Dentistry Research manifests itself as cretinism. When it affects adults Center and Advanced Studies. (especially middle-aged women), it is known as Universidad Autónoma del Estado de México (Autonomous 9-11 myxedema. University of the State of Mexico). This condition can be classifi ed into two categories: primary hypothyroidism, when the defect is intra- This article can be read in its full version in the following page: thyroid, or secondary hypothyroidism, in which http://www.medigraphic.com/facultadodontologiaunam 134 Reynoso RME et al. Congenital hypothyrodism and its oral manifestations CHT is a birth defect which can represent a pediatric CLINICAL CASES emergency. In cases when it is not timely treated, it can elicit serious consequences, among which irreversible Case 1. 7-year-old female patient, attended the mental retardation can be mentioned. CHT natural clinic seeking dental treatment. Pertinent information history has dramatically changed in recent years as was provided by the patient’s mother. Non-pathological a consequence of neonatal screening (NS) programs. personal history details were as follows: the patient These programs have the aim of detecting disease in was the product of a third pregnancy, third delivery. all apparently healthy newborns (NB).3-4,11,13,14 Dystocic delivery due to preeclampsia. Upon arrival NS programs have revealed the fact that worldwide to the clinic, the patient weighed 18 kg and measured CHT prevalence is two to three cases per 10,000 births 1.03 meters. (NB). Nevertheless, frequency variations related to Pathological history details were the following: population or geographic areas have been described.3,4,14 congenital hypothyroidism determined at birth with the The main causes which trigger CHT are: a) help of neonatal screening. The patient was at the time incomplete or aberrant migration of the thyroid outline; under medical treatment with levothyroxine (75 mg per b) defective thyroid growth or differentiation, which day) and levocarnitine (1 spoonful every 12 hours). could result in thyroid agenesis, and c) defects in the The rest of apparatus and interrogated systems were biosynthesis of the thyroid hormones. The fi rstly and denied. secondly mentioned cases exhibit predominance for Mesiofacial clinical examination revealed female gender.4,5,8 Table I contains a list of the most orthognatic, symmetric profi le. Oral cavity examination common CHT cases. revealed primary dentition, macroglossia, non- Female predominance is a particularly interesting determined terminal planes due to absence of teeth 75 characteristic of primary CHT epidemiology. and 85, bilateral class I canine relationship, upper and Nevertheless, to this date it remains unknown whether lower Baume II arch type, 50% vertical overbite, 3 mm women are more susceptible to CHT or whether horizontal overbite (Figure 1). CHT-affl icted female fetuses possess greater uterine X-ray studies revealed teeth 46 and 36 about to survival when compared to male phoetuses.3-5,14 erupt into the mouth. The patient’s age notwithstanding, Dental characteristics of child hypothyroidism teeth 51, 52, 61 and 62 exhibited full root formation. are the following: vertical facial growth, decrease of Teeth buds 11, 12, 21 and 22 exhibited one-third root length and skull base angle, thick lips, large-sized formation when, according to eruption chronology, tongue (macroglossia), which, due to its position, they should be already present in the mouth. Teeth 74 frequently elicits anterior open bite and fanned-out and 84 exhibited short roots (Figure 2). anterior teeth. Macroglossia can be congenital or The patient did not complete dental treatment due acquired. Congenital macroglossia can be caused to the fact that she resided out-of-state, in the state by over-development of the individual musculature, of Oaxaca; nevertheless, it was decided to include and becomes evident during the subject’s the report because the case presented eruption delay growth. Primary and permanent dentition present and short roots in teeth 74 and 84, which are all dental characteristic eruption retardation, and although characteristics of congenital hypothyroidism. teeth reach normal size, they are frequently crowded Case 2. Two-year and fi ve-months-old patient, who due to the small size of the jaws. Oral respiration attended the clinic seeking treatment for dental caries. and secondary irritative hyperplasia can be present. Indirect interrogation was conducted with the mother. Structural dental alterations can equally be present, Non-pathological history was as follows: first mainly in the root (open apexes permanence pregnancy, first delivery, eutocic (vaginal) delivery and short-root appearance), as well as large pulp of a normal evolution pregnancy. Upon arrival to the chambers caused by slow dentinwww.medigraphic.org.mx formation. Enamel clinic, the patient weighed 15 kg and measured 89 hypoplasia can be found among development centimeters. anomalies. Endocrine alterations are of great dental Pathological history was as follows: congenital and medical importance; therefore, it is paramount hypothyroidism determined at birth with the help of to ascertain which is the best dental treatment to neonatal screening. At that time, the patient was under observe with these patients.6,9,10,15-18 medical treatment of levothyroxine (25 μg per day). The objective of the present article was to report The rest of apparatus and interrogated systems were two clinical cases of female patients who attended the denied. paedodontics specialty clinic at the State of Mexico Clinical examination revealed orthognatic, University, having been diagnosed with CHT. symmetrical brachyfacial profile. Oral cavity Revista Odontológica Mexicana 2014;18 (2): 133-138 135 B D Figure 1. Case 1. 7-year, one-month-old patient. A) Front picture, B) upper occlusal picture, where primary dentition can be observed, C) lower occlusal
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