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Ashley Mires
Ashley Mires,
Category: Cardiology
Satisfied Customers: 35
Experience:  Internist at Chest & Critical Care Consultants
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I am scheduled for oral surgery in 3 days, to have bottom 6

Customer Question

I am scheduled for oral surgery in 3 days, to have bottom 6 teeth pulled, under local, I don't like general. I just had the top teeth pulled the same way 1 month ago.
I have been very sick for 2 months, low sodium, hospitalized for it 2 times, wearing off steroids for lupus, and will up day before surgery and after because I am very low dose and have no adrenal function.
I have been having a lot of PVC's which I have but when thyroid gets high they get way worse. At night I am having bradycardia, they think from the PVCs. The pst week they found my thyroid is high. I have hashimotos and have been on the same dose of meds for 5 years, and 10 days ago, my Free T4 went to 1.78 range is .57-1.47, and then 2 days ago my Free T4 to 1.95. My t3 is normal. They are having me go way down on my dose of thryoid but it takes 4 or more weeks to come down. My ??? is it ok to have teeth pulled now, I have read people with high thyroid undergone oral surgery with general are at risk?? I am not having general. I called the surgeons office and they woman who answered the phone said I should be fine. I see my doctor today to discuss halter monitor for heart stuff and I will ask him too.
What is the protocol for oral surgery under local with an elevated free t4?
Submitted: 1 year ago.
Category: Cardiology
Expert:  Ashley Mires replied 1 year ago.

Hyperthyroidism presents as a problem in patients going in for oral surgery because their bodies can react differently to the various medications used in dentistry, particularly sympathomimetics such as epinephrine, which is commonly used in local anesthesia quite often. The concern is that epinephrine and drugs like it could cause a patient with elevated thyroid hormone to go into a hypertensive crisis or even have cardiac dysrhythmia due to them being so sensitive to these types of medication. Therefore patients with hyperthyroidism require additional risk preventative measures before undergoing oral surgery with local anesthesia. Make sure your oral surgeon is aware of your thyroid levels if he is not already. Based on the levels you've indicated in your message, however, your thyroid is not extremely elevated and I don't think that there is much cause for concern. I suspect that your thyroid levels were thrown off from being sick and being treated with harsh medications for the other conditions you've had the last couple months. They'll likely return to their normal state quickly--however I'll note that it's unusual to go from hypo to hyperthyroidism with a diagnosis of Hashimoto's disease. It should be the other way around.

Again, as long as your oral surgeon is aware of your thyroid levels, I'm sure everything will be smooth sailing. This risk I've talked about above is more of a problem when the patient has much higher thyroid levels than you do.

Dr. Mires

Customer: replied 1 year ago.

They don't use the epinephrine on me, they know I get all jittery, they just use the regular numbing shots. They tell me I am amazing because I only need that but I hate anesthesia.

Expert:  Ashley Mires replied 1 year ago.

I don't think you have anything to worry about if that's the case.

Dr. Mires

Expert:  Ashley Mires replied 1 year ago.

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Dr. Mires