Thyrotoxicosis Dental Risk — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementThyrotoxicosis Dental RiskORE Part 1

A patient with uncontrolled thyrotoxicosis requires emergency extraction of a painful infected tooth. Which acute complication is of greatest concern during treatment?

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Correct answer: A — Thyroid storm

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct. Thyroid storm is an acute, life-threatening exacerbation of thyrotoxicosis. Infection and surgical or procedural stress are recognised precipitants, so an emergency extraction in a patient with uncontrolled disease presents a risk of precipitating crisis. Its clinical features include hyperthermia, marked tachycardia, cardiovascular decompensation and central nervous system disturbance. Hypothermia and bradyarrhythmia are more consistent with severe hypothyroid physiology, not thyrotoxicosis. Hypoglycaemic coma is not the characteristic acute complication of hyperthyroidism or dental treatment in this setting. Mandibular osteoporosis, even if altered bone metabolism were relevant, would be a chronic issue rather than the immediate procedural danger.

Reference: de Mul N, Damstra J, Nieveen van Dijkum EJM, et al. Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review. British Journal of Anaesthesia. 2021. https://pubmed.ncbi.nlm.nih.gov/34389171/