Medical Emergencies · patient case question
All of the following are features of hypothyroidism EXCEPT:
Patient case: The Hypothyroid Patient with an Aching Jaw
Patient: 54-year-old female
Chief Complaint: Generalized aching in the jaws and fatigue.
Background: Hashimoto thyroiditis diagnosed two years ago. Recently also investigated for bone pain; laboratory work shows a raised alkaline phosphatase with low vitamin D.
Medications: Levothyroxine
Vital Signs: BP 118/74 mmHg · HR 58 bpm · RR 14 · T 97.4°F
Findings: Dry cool skin, coarse hair, periorbital puffiness, slow relaxation of deep tendon reflexes. Intraorally the tongue is enlarged with scalloped margins. Panoramic film shows generalized reduced bone density.
Show answer and explanation
Correct answer: B. Accelerated dental eruption
- A. This IS a feature. Reduced gut motility produces constipation.
- B. CORRECT — this is the EXCEPTION. Hypothyroidism DELAYS dental eruption and exfoliation, it does not accelerate it. Thyroid hormone drives skeletal and dental maturation; when it is deficient in childhood (cretinism), the result is delayed eruption, retained primary teeth, delayed epiphyseal closure and short stature. Accelerated eruption is a feature of HYPERthyroidism.
- C. This IS a feature. Reduced metabolic rate and reduced sweating produce dry, cool, coarse skin and cold intolerance.
- D. This IS a feature. Reduced basal metabolic rate and fluid retention (myxoedema) produce weight gain despite unchanged appetite.
Note: Oral features of hypothyroidism: macroglossia, delayed eruption, enamel hypoplasia, and delayed wound healing. In HYPERthyroidism you see accelerated eruption, premature exfoliation, osteoporosis of the jaws, burning mouth and increased caries. ⚑ Note also that EXOPHTHALMOS is a feature of GRAVES DISEASE specifically — an autoantibody-driven orbitopathy — and NOT of thyroid hormone excess in general.
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