THYROID DISEASES-II -FTI TESTS

FREE THYROID INDEX TEST-FTI

This is an estimation of free thyroid hormone most importantly T-4 which is the major contributor of the thyroid secretion but minor contributor of the effects of thyroid.

Usually the secretion of T-4 is more in hyperthyroidism and less in hypothyroidism as there may not be much change in the secretions of T-3.

Hence T-4 estimation which is freely circulating in the blood is very important index of assessing the patient's condition.Even though the effects of thyroid is mostly contributed by T-3 it is not important to asses it as a factor because most of the T-3 conversions from T-4 happens only in circulation and not within the thyroid gland

Also this not a separate test rather an estimation of T-4 level which is freely circulating in the blood by mathematical relationship between Resin Triiodothyronine Uptake(RT3U) and serum T-4 levels as follows

FTI = TT-4 x RT-3U/mean serum RT-3U

TT-4 = Total serum T-4;

FTI is higher in hyperthyroidism in which TBG the thyroxin binding globulin is less and vice versa
Alternatively thyroid functions can be assessed by TSH test.TSH the thyroid stimulating hormone is secreted by the pituitary gland according to the thyroid functions.
If pituitary secretes high TSH secretions which elevates the serum TSH level above the normal that means the thyroid gland is underacting which is known as Hypothyroidism.
But if the pituitary secretions of TSH is less which is reflected by the depression of serum TSH level then it means the thyroid gland is over acting which is known as Hyperthyroidism
The normal range of serum TSH level is 3.9 to 4.6 milliunits/Liter.(American Thyroid Association)

THYROID DISEASES-I

THYROID-A VIEW

The thyroid gland which is looking like a butter fly with  spreaded wings is situated in the anterior(front side)of the neck or throat just below the laryngeal prominence (Adam's Apple).It contains two lobes on either side spreaded like the wings of a butterfly.

Thyroid gland is one of the largest ductless gland (endocrine) in our body and it controls many important body functions such as rate of use of energy sources.protein synthesis and controls the body's responses to other hormones.

The thyroid gland synthesizes,stores and secretes hormones which are controlling and participating the processes like growth and protein anabolism.These hormones are as follows:-

1.Tetraiodo thyronine or thyroxine (T-4)-Less active-More stable-and Major secretion of the gland

2.Triiodo thyronine (T-3)-More active-Less stable-Minor secretion of the gland.

A portion of the thyroid gland is secreting a hormone known as calcitonin which is controlling calcium metabolism.

The sequences of thyroid secretion of hormones are as follows,

In our brain system there is a gland like a peanut known as thalamus.Below the thalamus a minute part of the brain is known as hypothalamus which is controlling all our endocrine systems including thyroid.

Hypothalamus secrets a hormone known as Thyrotropin Releasing Hormone(TRH) which inturn stimulates anterior pitutary gland to release Thyrotropic Hormone or Thyroid Stimulating Hormone(TSH) which inturn stimulate thyroid gland to secrete its hormones T-4 and T-3 which on free circulation will send the negative feed back signals to the anterior pitutary to stop to secret the TH.The process will continue like a cycle.Thus the amount of the free circulating hormones are maintained in a constant level.

Synthesis Thyroid hormones are synthesised by thyroid gland by combining tyrosine with the available iodine.

Iodine containg foods like sea foods are essential for the synthesis of thyroid hormones.The food release in the plasma iodide in an inorganic form.

Before synthesis starts a process of manipulating the iodide ion by a process known as the organification which involves the iodide oxidised by peroxidase and bound to tyrosyl residues within the thyroglobulin molecule as follows

1.The inorganic iodide from the plasma is trapped by the gland and the process is known as iodide pump

2.The inorganic iodide has to undergo the organification after thatTyrosine combines with iodide to form Mono Iodo Tyrosine(MIT)

3.MIT binds with another iodide ion to form Di Iodo Tyrosine(DIT)

4.Two DIT couples to form the stable T-4,the Thyroxin

5.One MIT and one DIT couples to form the unstable T-3 which is highly active

Hormone Transport
1.After the gland get stimulated by TSH (Thyrotropic Hormone or Thyroid Stimulating Hormone) from the anterior pituitary gland the T-3 and T-4 are cleaved from the thyroglobulin and released into the blood circulation.
2.In the blood the hormones are bound up with plasma proteins like thyroxine binding globulin (TBG),Prealbumin and Albumin in order to protect them from inactivation by early metabolic processes.These protein carriers help the hormones to reach the site of action very easily.
Metabolism Mostly occur at pituitary,liver,and kidney by conversion of 80% of T-4 into T-3.
The active T-3 is responsible for 99% of the thyroid activity in our body and its abnormal elevation and fall are the complete representations of thyroid dysfunctions.
T-3 is further degraded step by step by a process of deiodization finally converted to thyronine and excreted in feces and urine.
Functions of thyroid hormones
1.Growth
2.Delelopment of our body
3.Energy production by increasing the rae of basal metabolism.
4.Tissue sensitivity to hormones like adrenalin and there by affecting cardio vascular system like increasing heart rate,blood flow,cardiac out put,metabolic rates
5.Increasing the activity of nervous system.
6.Causing tremour.
7.Thyroid over activity may cause sleepiness and tired
8.Thyroid underactivity may cause somnambulance.
9.Affecting lipid meabolism.
Thyroid tests-A.Serum Total T-4 Test.
1.Radio immuno assays these tests more sensitive and rapid to assay total thyroxine T-4.which will indicate the total availability of hormone to the tissues.
Unless otherwice not affected by other factors like pregnancy kidney failure,or liver damage an elevated Total T-4(TT-4) may indicates Hyperthyroidism and a dippressed T-4 may indicate Hypothyroidism
Serum total T-3 Test
This sensitive and most specific test indicates measure of TT-3.
This test is more accurate and help early detection in hyperthyroidsm as the elevation of TT-3 is immediate and more quicker than TT-4.Many of the symptoms of hyperthyroidsm is due to the elevation of TT-3.
But on the contrary in hypothyroidism this test is not reliable as even though there is a fall in TT-3 but will stay at the normal level.In rare case the TT-3 may be low.These test may also mislead by those factors which affect the test result of TT-4.
Resin T-3 uptake(RT,U)
This test will clarify whether the abnormal T-4 levels are due to thyroid disorder or a disorder by protein uptake because it evaluate the binding capacity of TBG
This test read more accurate changes of the abnormal levels of the hormone in the blood.
Serum Thyrotropin(TSH) and Sensitive TSH Assays
a)Serum Assay This assay results are more reliable and sensitive as the hypothalamus - pituitary axis is more sensitive in responding even a minute variations of the circulating blood thyroid hormones to release or stop the TSH.This axis is very sensitive to indicate hypothyroidsm as a small dip in the blood hormone will receive a quick compensatory response from the hypothalamus - pituitary axis.
The TSH levels may be elevated even much before the TT levels are dipped and very useful and easy to detect Hypothyroidsm in advance.
This test is not reliable to asses Hyperthyroidsm as the hypothalamus-pituitary axis is varyingly responding to the elevated TT in plasma
Sesitive Assay This is an advanced technology using immunoradiometric methods instead of the old radioimmune assay and is very expensive.This is the most occurate method of detecting thyroid defects.
This is a very useful test to monitor paients receiving hormone replacement therapy to control hormone over exposures,since over exposure to thyroid hormones may precipitate unwanted elevation of liver enzymes,bone demineralizations and ECG effects.


 
  

V-ORAL CARE-MISCELLANEOUS ORAL INFECTIONS

COMMON ORAL INFECTIONS-TREATMENTS

Candidiasis or Thrush The causative organism is Candida albicans.It is one of the common oral oppertunitic infections if we do not properly take oral care.

Common symptom is pain with milky curd like secretions make our mouth awkward with bad odour.

There is no OTC treatment for and a doctor has to be contacted.

Oral cancer .The most common oral cancer is squamous carcinoma .

The appearances are red or white ulcer like lesions or tumors.

Patients with any change in colour of the tongue,sore throat that does not heal,and persistant bleeding should immediately report to doctor.

Tobocco and alcohol are the common risk factors

Treatments are mostly by radiotherapy alone or with surgery invoved by excision for small lesions or enblock excision for larger lesions or neck incision if lymphnodes are involved.

Alcoholic drinks including gargles should be avoided.

OTC treatments should not be followed without the concern of a doctor.

 

 

IV-ORAL CARE-ORAL LESIONS

OTC PRODUCTS FOR ORAL LESIONS

Cranker sores are also known as recurrent aphthus ulcers or syndroms 

These cranker sores are always appear within the mouth on or undrer the tongue,on the roof of the mouth and the inner portion of the chin. 

They are white or grey lesions and shallow in appearence sorrounded by reddish inflammations .They make inconvenience to chew,to swallow and to talk.

They are usually self healing within a week if left unattended.

There are two types as Simple and Complex

Simple These may appear three or four times in a year and heal in a week.Usually occuring in the age of 10 to 20 years.

Complex These are less common and occur to people who previously had these ulcers.

A cranker sore differ from Cold sore as the later is due to microbial infection and contageous and always appear out side the mouth such as under the nose whereas cranker sores always appear inside the mouth and lips and it is not by infections.Cold sores are fluid filled and more painfull where as cranker sores are shallow lesions sorrounded by reddish iflammations

Causes The exact cause is not known but stress or mouth injury may precipitate these ulcers.Citrus fruits and acid vegetables may exagerate the condiions.Some times a sharp tooth,or an ill fited denture may also generate canker sores.Deficiency of vitamin -B may be cause for complex cranker sores

OTC-Treatments

Proectants such as Orabase,Denture adhesives,and Benzoin tincture are tried in which denture adhesives was disproved by FDA
Local anesthetics like benzocaine,and butacaine are the common products used in OTC pain releif.Other ingredients approved by FDA are,
1.Benzocaine as 5 to 20%
2.Benzyl alcohol as 0.05 to 0.1%
3.Hexylresorcinol  as 0.05 to 0.1%
Examples of OTC local anesthetic products approved by FDA are,
1.Anbesol
2.Blistex
3.Orajel
4.Orajel Cover-Med
5.Benzodent
The products contain Phenol,Menthol,Camphor,and Clove oil are discouraged because of their irritating nature
Aspirin should not be used and retained in the mouth or placed on a lesion as a pain releiver 
Amelexenox is now on a status of approval by FDA to releive painfull crank sores
Coldsores or Fever blisters These are from infective origins usually by Herpes Simplex and are very painful and always filled with fluids and  mostly  these cold sores appear out side the mouth,such as lips,and under the nose.Stress,fever,minor infections or sunlight may provoke the sores.
At the beginning it start with burning,itching and numbness,followed by the formation of red papules of fluid containg vesicles.These vesicles eventually rupture to form crusts.These cold sores will automatically heal in 10 to 14 days without forming scares
OTC medications For cold sores medications are available on OTC
1.Skin softening products such as emollient creams,vasaline cream,petrolatum cream.
Benzocaine a local anethetic contain Orabase can be used to releive the pain.
The American Dental Association discourages the use of highly rritant products such as caustic agents like phenol,silver nitrate,benzoyle peroxide,sulphur,and various anti-acne products and corticosteroids as these products may worsen the conditions.
2.If infection become severe antibiotics like Bacitracin and Neomycin containing creams can be applied
3.Sun protecive Lip-cream can also be applied
4.L-lysine can be taken orally with a daily dosage of 300-1200mg.to accelerate recovery and suppress the recurrence. 
Prescription Products 1.Acyclovir 400 mg is taken by oral daily on prescription.Also a 5% cream of acyclovir can also be applied four times daily to minimise the severity.
3.A oral dosage of Famciclovir in the srenghth of 125 mg,250 mg,and 500 mg ,three times a day has also been studied.

III-ORAL CARE-TEMOROMANDIBULAR JOINT SYNDROM

TEMPOROMANDIBULAR DYSFUNCTION

It is a term used to include pain and a non coperative working relationship between the chewing muscle and the joint.

Symptoms Dull and aching pain around the ear produces headaches,neck aches limited opening of the mouth with a popping sound.

Grinding teeth and biting abnormalities are the risk factors.

Treatments include applying moist heat to he jaw,muscle relaxants with doctors advise ,a diet of soft foods,biting plates,correcting the occlusion, or surgery.

OTC pain releivers like Paracetamol can be used.

TEETHING PAIN

The American Dental Association has not approved any OTC pain killers to be taken by a baby like Medomol syrup or drops for teething pain.

Releifs can be possible by using local anesthetics like benzocaine containing baby orajel

If a teething child is present with fever better to contact a physician.

XEROSTOMIA

I is a condition at which the salivary glands are not properly functioning leads to dry mouth as seen in Sjogren's syndrom.

Artificial salivas are available as OTC and can be used.The ADA has aproved the following OTC arificial salivas including Moi-stir;Salivart;Xero-Lube;and Saliva substitute 

II-ORAL CARE -GINGIVITIS

GINGIVITIES-PREVENSION

If we do not care our mouth and buccal cavity there are many problems would arise including gingival inflammations.Gingivas under the teeth is fixed and gingiva attached with our inner jaws are movable but both are proned to get inflammations.

A inflammation the gingiva will be enlarged with a bluish hue due to engorged gingival capillaries and a slow venous return

Causes Gingival inflammations are caused by microbial damages if cellular and intercellular gingival tissues.There are chronic and acute gingivities.In chronic the gingival inflammations markedly localised and generalised.The gum would readily bleed on probing and brushing.Painful sensitization.The patient should seek a medical assistance.

For OTC treatments oral anesthetics include euginol(clove oil) and benzocaine (Oragel) are available.Clove oil has antiseptic property also.Paracetamol can also give a pain releif but the patient should seek the medical advice to get cure.

Periodontal Disease is formed if gingivitis is left untreated.In periodontal disease the periodontal ligament attachment and the alviolar bone support of the tooth deteriorate

Acute Necrotizing Ulcerative Gingivitis (ANUG)

It is known by the name Trench Mouth in which necrosis and ulceration of gingival cells occur with underlying inflammations.This condition is usually seen in young adults and teens.

Symptoms are included as severe gum pain,with foul taste,bad odour,bleeding and increased salivary secretions. 

The causative organisms are unknown but it is well beleived that it is associated by the over growth of spirochette and fusiform organisms which are usually present in the mouth.

Anxiety,stress,smoking,poor oral hygeine,malnutrions may also contributors of risk.

Treatments should be carried out by a dentist.The prescription include Penicillin-VK the oral penicillin of phenoxy methyl or ethyl penicillin as a potassium salt is more preferable because of its acid stability.Metronidazole can also be used to controll the lesions.

OTC Products These are for a temperory releif includes paracetamol.clove oil and oragel.Aspirin and any salicylate should not be used if bleeding is there

An oral mouthwash contains 1.5% hydrogen peroxide solution may be used.

 

OTC DENTAL MEDICATION

COMMON TOOTH PROBLEMS-TREATMENTS

Dental caries or cavities

These problems start with when we are not following the proper tooth care,then our tooth are attacked with cariogenic microbes which are growing and implating in our tooth.

The causative organisms are Streptococcus muans and Lactobacillacae,these organisms release lactic acid which demineralise the enamel and produce cavities.

Diet contains high content of white sugar (sucrose) are also another causative.Sucrose is converted by the microbes into volatile acids that destroys enamel.Fructose and Lactose are less cariogenic.

Artificial sweetening agents such as xylitol,sorbitol,and aspartam are not cariogenic.

OTC products for a time being releif until to reach a doctor includes euginol,benzocaine (Anbesol,Oragel),Aspirin and Paracetamol

Plaques and Calculus

Plaque is a sticky material formed by the attachment of bacteria to the pellicle a thin mucoprotein that adhere with the enamel immediately after cleaning the tooth.When the bacteria attached with the pellicle it produces plaques.Plaques can be easily removed by brushibg the teeth with a dentifrice and can be prevented by brushing withou paste regularly after every meals containing sugar and milk.Night brushing with a paste is very important

Calculus or tartar is formed if the plaque is not removed in 2 to 3 hours.The plaque begins to calcify by the saliva and becomes calculus.Once calculus formed then it should be removed only by a dentist.

OTC Treatments

a.Soft and round ended bristles containing tooth brushes are perfect.

b.Irrigating products such as Dento spray,Hydro-pic are used.Withese spraying device one can rince and wash with high pressure stream of water through a nozzle.Gently lift the free gingiva to rince the cervix
c.Dental floss or tape are also can be used as perfect adjuncts for oral hygene.These are available as waxed or unwaxed as per our tastes of interests.Waxed floss or tapes are recommonded in case of tight teeth with little gaps as they can pass through the gaps very easily without shredding.
The American Dental Association (ADA) has recommended  the following brands Butler,J&J,Floser and Oral-B
d.Dentifrices are products that are used to remove plaques and stains with a brush.(e.g)Tooth pastes, Mouth washes,cosmetic teeth bleachers,desensitizind agents etc.etc.
1.Tooth Pastes These are very useful to clean the teeth like by a soap to look perfect by removing bad odour and taste,stains and plaques if use regularly at night and in a proper manner.
Whenever we buy tooth paste we should read its contents.A perfect T.P must contain the followings:-
A)Abrasives are meant for plaque and debris removal and includes any one of the followings 1.silicates;2.sodium bicarbonate;3.dicalcium phosphate;4.sodium metaphosphate;5.calcium pyrophosphate;6.calcium carbonate;7.magnesium carbonate and 8.aluminium oxides.9.Potassium flurides
B)Surfactants are soap forming substances acting as foaming agents and their detergent properties are very useful to clean the debris.(e.g.)1.sodium lauryl sulphate;2.sod.dodecyl benzene sulfonate
C) Humectants are wetting agents to keep the product away from drying.(e.g.)1.sorbitol;2.glycerin and 3.propylene glycol
D) Suspending agents are the agents giving proper thickness and rigidity to the produts (e.g.) Tragacanth;Methyl cellulose and Karaya gum.
E)Flavouring agents are agents to give odour and tastes includes sorbitol;aspartam;or sachcharin
Cosmetic Whitening Agents are special ingredients and the preparation should not be used for daily purpose but weekly once is advisable as they are bleeching agents to offer a cosmetic white shining to your teeth.(e.g)10% sodium carbamide;glycerin oxide;proxygel.
These preparations are harmful if used daily and frequently.The side effects include alteration of the normal flora;tissue irritation;teeth sensivity and gingivities
Desensitizing agents These are the agents meant for minimising teeth sensitive pains by cold,heat and touch.These ingredians are non-abrasives and could be included in special preparations and should be used as per the dentist's advice.(e.g.)5%Potassium nitrate containing such as Denquel;Promise;Fresh Mint Sensodyne
Disclosing agents These are the products at the doctors desk used to find out the exact place of plaque formations.These products after use should be thoroughly washed and rinsed out and should not be swallowed.The American FDA approved products includes D&C red No-28;FD&C Green No-3
Mouth Washes are the liquid preparations usually contains astringents,demulsants,detergents,flavours;germicides and fluorides.
There are many types as follows
cosmetic MW -The are used to remove bad odours and taste can be used cosmetically as a mouth freshner.These are prepared with or without alcohol but includes phenol and mint.
anti-plaque MW -These are medicated products include Listerine and Peridex.
fluoridated MW-These are meant for cleaning used as gargle for expectoration.After use any thing to be eaten or chewed should be atleast after 30 minutes only.American Dental Association has approved the following products such as Act anti-cavity Denal Rinse;Act for kids;Fluorigard Anticavity Dental Rinse