Abstract
In this case, by paying attention to the abnormal findings in the patient during periodontal treatment, we were able to detect and cure the patient of Hashimoto's thyroiditis (chronic thyroiditis) associated with severe hypothyroidism that had been overlooked in earlier medical consultations and blood tests, thereby contributing to improvement of the health of the patient. We would like to discuss and report the relationship of Hashimoto's thyroiditis with periodontal disease, which is not well known, especially the bleeding tendency. Easy bleeding from the gingival sulcus was observed during the initial preparation of the full mouth for periodontal treatment in a patient with generalized severe chronic periodontitis. Despite the patient's repeated visits to three medical institutions, including the family doctor, a secondary medical institution (hematologist), and an oral surgeon, the possible existence of a hemorrhagic disease continued to be denied. A day after periodontal tissue regeneration therapy using enamel matrix derivative (EMD) for the maxillary anterior teeth, we observed abnormal bleeding and formation of large clots from the gingival sulcus. Then, after persistent and repeated physician referrals from our clinic, the patient was finally diagnosed as having Hashimoto's thyroiditis (chronic thyroiditis), an autoimmune disease, at the fourth medical institution (thyroid specialist), more than one year after the first visit to our clinic. The patient had severe hypothyroidism and was in a life-threatening condition. After thyroid hormone replacement therapy, his weight decreased from 90 kg to 60 kg without exercise or dietary restriction, due to improvement of the generalized edema. After the improvement of the hypothyroidism, we undertook periodontal tissue regeneration therapy using EMD on the following day, the right side of the cheek was swollen, however, no significant postoperative bleeding was observed. The periodontal tissue findings significantly improved and the patient has maintained good periodontal health for 6 years after transtition to the SPT. This case suggests that the peculiarities of periodontal treatment, which involves routine observational treatment, may lead to early detection of abnormal findings, which in turn may contribute greatly to the overall health of the patient.
