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92]

CASE REPORT

Impact of thyroid hormone dysfunction

on periodontal disease
Shaila Kothiwale, Vishal Panjwani
Department of Periodontics, KLE’s
econd most common glandular
VK Institute disorder
of Dental of the endocrine system and is increasing predominantly among women. Thyroid disease can lead to
Sciences,
KLE University, Belgaum, Karnataka, India

s impact on periodontal disease progression, systemic health of the patient, and the management of periodontal disease. The report emphasizes the need for f

Address for correspondence:

Dr. Shaila Kothiwale, Department of
Periodontics, KLE’s VK Institute of Dental
Sciences, KLE University, Nehru Nagar,
Belgaum - 590 010, Karnataka, India.
Key words: Hypothyroidism, oral healthcare, periodontitis, thyroid hormone
E-mail: shailakothiwale2000@yahoo.co.in

INTRODUCTION dysgeusia, delayed eruption, altered tooth

morphology, and delayed wound healing.
[2]

Inflammation is a primary pathologic feature of

periodontal disease. A number of risk factors However, limited data are available regarding
including systemic diseases influence individual the relationship between thyroid hormone
susceptibility to periodontitis. Periodontal imbalance and periodontal health. This case report
infections influence overall health and the course presents a patient with periodontal destruction
of several systemic diseases such as diabetes, that is associated and influenced by
cardiovascular disease, respiratory diseases, and hypothyroidism.
preterm low birth weight. It is thus, a two-way road
with systemic host factors and periodontal CASE REPORT
inflammation generating widespread effects with the
potential to induce adverse systemic outcomes. A 30-year-old female patient reported to the
department of periodontics with the chief complaint
Thyroid hormones play an important role in the of bleeding gums and an increase the size of gums
regulation of growth, development, and since 6 months.
metabolic functions of the body. Thyroid disease
can lead to imbalance in the homeostasis of the The patient was apparently normal 6 months
body and affect the healing capacity of tissues.
[1]
earlier, after which she noticed spontaneous
The common oral findings in hypothyroidism episodes of bleeding from the gums that was
include the characteristic macroglossia, sudden in onset and had gradually progressed
since then.

She also noticed a gradual increase in the size of

gums

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DOI:
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Kothiwale and Panjwani: Impact of hypothyroidism on periodontitis
to an extent that it was aesthetically displeasing. The
patient complained of oral malodor. The past dental
history revealed that the patient had undergone oral
prophylaxis twice. Nevertheless, the removal of local
factors did not result in any decrease in gingival
swelling and bleeding.
On intraoral examination, the oral hygiene index
score suggested that the status of oral hygiene was
fair. There was generalized gingival inflammation
[3]
seen with a reddish pink color of the gingiva with
rolled out margins and blunt interdental papillae.
The interdental and marginal gingivae in the
mandibular anterior region were deflected away from
teeth [as seen in Figures 1 and 2].
On clinical examination, there was minimal local
deposits, generalized grade II type of inflammatory
enlargement with loss of stippling, spontaneous
bleeding, and the presence of periodontal pockets of
5-7 mm.
[4]
The radiovisiograph presented with horizontal
and vertical bone loss with generalized 10-40%
of bone reduction [as seen in Figure 3]. The
fremitus test was positive with the presence of
horizontal as well as angular types of wear facets
in relation to the mandibular anterior teeth.
The patient had a systemic history hypothyroidism
since the past 2 years and was apparently on
systemic thyroxine (100 mg/day). She had
discontinued the medication since the past 4-5
months. Since the patient showed a lack of
compliance with systemic treatment, a blood
examination was carried out to review the systemic
thyroid hormone levels. On chemiluminescent
immunoassay, increased thyroid stimulating hormone
(TSH) levels more the 150 IU/mL were seen. Thus,
increase in the severity of hypothyroidism was
noted. On further counseling, she also revealed an
increase in body weight, along with increased
puffiness of the face since the past 6 months.
Treatment
In the present clinical scenario, the female patient
was systemically compromised presenting an
uncontrolled state of hypothyroidism with levels of
thyroid-stimulating hormone (TSH) greater than 150
IU/mL. Hence, she was referred to an
endocrinologist prior to the commencement of any
dental treatment. Accordingly, she was prescribed
150 mg of systemic thyroxine per day. Aher
consultation, the etiotropic phase was initiated that
comprised a thorough ultrasonic scaling with
patient education and motivation regarding oral
hygiene. She was then kept on a through
maintenance program for a period of 8 weeks to
evaluate her compliance with systemic therapy as
well as oral hygiene maintenance. Also, as
mentioned in the clinical findings it was
appreciated that the gingival status with severe and
spontaneous bleeding from the tooth supporting
tissues did not correlate with the presence of local
deposits. Similarly, at the end of 8 weeks it was
noticed that there was a further improvement in
the oral hygiene maintenance but the gingival
bleeding scores did not improve significantly. At
the end of 12 weeks, there was an improvement in
the thyroid hormone levels within the normal
range, along with distinct reduction in the bleeding
scores. The periodontal charting at the end of 12
weeks showed that there was a marked
improvement in the gingival status, with persisting
periodontal pockets only in the maxillary posterior
teeth. Hence, a surgical therapy was planned
comprising pocket reduction in relation to the
posterior quadrants. Coronoplasty was done with
respect to the mandibular anterior teeth to relieve
the trauma [as seen in Figure 4].
As there is a delayed response of tissues to
healing, the patient was educated regarding the
complication of delayed healing that is
encountered in a state of hypothyroidism and was
simultaneously motivated
Figure 1: Preoperative gingival inflammation with
photograph showing marked minimal amounts of plaque
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Kothiwale and Panjwani: Impact of hypothyroidism on periodontitis

and calculus Figure 2: Photograph restoration of thyroid
showing interdental hormone levels within
and marginal gingiva
normal limits and TSH
deflected away from
the mandibular levels at the baseline
anterior teeth that were 150 IU/mL
were reduced to 5
Journal of the Scientific
Society, Vol 43 / Issue 1 / IU/mL) was
January-April 2016
clinical disease state
occurring when there is
insufficient thyroid
hormone available to the
target tissues. Serum
TSH concentrations Figure 4: Post-operative view
represent the most
at one year follow up visit
reliable indicators of
thyroid status. The
initiated, there was an
American thyroid improvement in the oral
association recommends
hygiene status and
that all patients should
immense reduction in
obtain a serum TSH
the bleeding scores. This
determination at the age
finding of increased
of 35 years and be
Figure 3: Radiovisuograph gingival bleeding with
followed up every 5
showing the osseous reduction minimal local factors
years.
[5]

may be due to the

to follow a stringent susceptibility of
In general, results
maintenance program demonstrating hypothyroid patients to
hereaher. She was then 4
elevated TSH (>5.5 infection. In
scheduled for a recall IU/mL) and low hypothyroidism, delayed
program every 6 circulating free t levels wound healing occurs
weeks, keeping a are indicative of due to decrease in the
check on the systemic hypothyroidism.
[6]
It is metabolic activity of the
thyroid hormone levels also a commonly fibroblasts.
[8,9]
Delayed
and her compliance prevailing disorder in wound healing may be
with the supportive the adult Indian associated with an
periodontal therapy. In population and is increased risk for
addition, the patient common among infection due to the
optimistically females.
[7]
Hence, the longer exposure of the
mentioned about determination of the unhealed tissue to
reduced puffiness influence of thyroid pathogenic organisms
noticed in the facial hormone imbalance in
region, along with manifesting clinically
periodontitis may be with increased gingival
reduction in the body important for the
weight. She also bleeding.
prevention of morbidity
showed a positive related to this
inclination toward condition. Patients with
improvement in oral hypothyroidism have
health-related quality increased subcutaneous
In the present clinical
of life and expressed scenario, the patient mucopolysaccharides
the desire to maintain a complained about due to decrease in the
regular maintainance bleeding gums with degradation of these
recall visit. minimal amount of substances. The presence
local factors. As the of excess subcutaneous
DISCUSSION therapy for mucpolysaccharides
periodontitis and may decrease the ability
Hypothyroidism is a hypothyroidism (the of small blood vessels to
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Kothiwale and Panjwani: Impact of hypothyroidism on periodontitis

constrict and may result oral healthcare
in increased bleeding setting, the goal
from infiltrated tissues should be to develop
including the mucosa and implement timely
and skin. However, in
[9]
preventive and
this case, we could not therapeutic strategies
elicit increased bleeding compatible with the
during the periodontal patient’s physical and
surgery, probably emotional ability to
because the surgical undergo and respond
therapy was initiated to dental care.
aher the restoration of
thyroid hormones Financial support
within the normal limits and sponsorship
and aher thorough Nil.
etiotropic phase.
Conflicts of interest
Hence, when treating There are no conflicts of
patients with thyroid
dysfunction in the interest.

36 Journal of the Scientific

Society, Vol 43 / Issue 1 / January-April 2016

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