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resulting in need for repeated curettage and hysterectomy with it's attendant
and malignant tumors (endometrial carcinoma). In more than half of the subjects
blood loss and menstrual irregularities. Menorrhagia has been reported in 32%
(Means 1948) and in 32.4% (Wg Cdr S Sampath, Col P Singh, BL Somani , Col
236.) of subjects with myxoedema. It may also lead to anovulation, infertility and
cal manifestations may take months and years to appear (Ingbar 1985). Further-
these patients do not exhibit clinically overt physical symptoms and signs. This
may lead to avoidable surgical interference and related complications. With the
(1)
possible in rapid and reliable manner. The diagnosis of various endocrine disord-
ers can be easily made and medical treatment can be properly instituted. The re-
sults are usually very gratifying as patient is virtually symptom free on adequate
treatment.
available from India. Mukherji and Ghosh (1984) reported low serum thyroxine
(T4) and tri-iodothyronine (T3) levels and normal levels of serum thyroid stimulat-
Chadha, D Balaiah, R Shah (1993), Only 31.8% of hypothyroid women had nor-
mal menstrual pattern in contrast with 87.8% of healthy controls (p < 0.001). The
ism. The relative frequency and type of menstrual disorders and the chronology
of the onset of reproductive dysfunction with respect to the onset and type of thy-
roid disorder have not been well defined. It is common practice to investigate for
thyroid functions when goiter or clinical symptoms and signs are present.
Present study was carried out to evaluate the thyroid function in larger
(2)
AIMS & OBJECTIVES
hypothyroid status.
(3)
REVIEW OF THE LITERATURE
bolic rate.
leston (1940). According to the formers account, Gallen in his De Voice briefly
described the gland. Vexalius in 1543 was first to give full description but it was
not till 1956 that organ was named the thyroid or oblong shield by Wharton.
The role of the gland in the body was subject of pleasant and interesting
speculation. Wharton suggested that the gland was there to round out and beau-
tify he neck "particularly in females to whom longer gland has been assigned",
others suggested it is lymphatic gland and a lubricant organ for larynx. Even as
late up to 1884, the gland was proposed "Vascular Shunt" cushioning the brain
King in 1836, who showed that some colloid of thyroid gland passed in to lym-
phatics and from there in to circulation. More detailed study of thyroid secretions
came in to the view after Bayliss and Starling coined the term hormone in 1902.
The relationship between thyroid and various body functions were studied by
(4)
gland was described in 1896 by Braumann who discovered high concentration of
this element within the gland. Gkyand Bownet (1900) identified presence of or-
be physiologically more potent and more rapid onset of action than thyroxine.
est endocrine gland, is a brownish red, highly vascularised organ situated ante-
riorly in the neck at the level of fifth, sixth and seventh cervical and first thoracic
vertebrae. It normally weights 25-30 g or 3 - 3-1/2 g/kg body wt. varying with
Its shape is like letter 'H' and consists of two lateral lobes and a connect-
ing isthmus. Each lobe is approximately 2.0 - 2.5 cm in both, thickness and width
at its largest diameter and is approximately 4.0 cm in length while the isthmus
measures 2 x 2 x 5 cms. The right lobe is more vascular than left and tends to
The thyroid is closely affixed to the anterior and lateral aspects of trachea
by loose connective tissue along the lower half of lateral margins of thyroid carti-
lage. The upper margin of isthmus lies just below the cricoid cartilage.
(5)
Two main pairs of vessels contribute to the major arterial supply. The su-
perior thyroid arteries arising from external carotids and inferior thyroid arteries
arising from subclavian arteries, enter their respective poles. The veins drain in
corresponding veins. The approximate blood flow is 4-6 ml/min/kg. It receives its
nerve supply from both adrenergic and cholinergic nervous system, the former
arising from superior middle and inferior cervical ganglia while latter from laryn-
called as acini or follicles. Each follicle is filled with the clear proteinaceous collo-
id, which constitutes the major thyroid mass. The average diameter of each fol-
licle is 200 µ and is lined by cuboidal cells becoming columnar when active,
while flat when inactive. The epithelium rests on basement membrane, which
separates follicular cells from the surrounding capillaries. 20-40 follicles sepa-
rated from each other by connective tissue, unite to form lobule, which is sup-
tide, calcitonin.
pounds are formed which influence the rate of cellular metabolism of the body.
(6)
Herrington (1939) stated that thyroid has specific affinity for iodine, which
enables it to utilize particularly all of this element which normally gains access to
the body. The iodine taken up by the thyroid is introduced in to tyrosine on thy-
tion. The true thyroid secretion is in all likelihood a peptide containing both thy-
(7)
THE IODIDE CYCLE
dietary sources i.e. food, water and via medication, diagnostic agents and use
of iodine, in food processing industries. Iodide absorbed from the gut enters in
the ECF, from there it is actively transported in thyroid follicular cells against
negative potential and then diffuses along the electrochemical gradient in to fol-
licular lumen, this biochemical mechanism is related to Na+ - K+, ATpase sys-
tem for phosphate bond energy. In addition, iodide is also generated in the thy-
fied and remainder is lost from gland as so called 'Iodine PATHWAYS AND
IODINE METABOLISH
(8)
½ in thyroid In blood in form of
Thyroxine
Tri-iodithyronine
α– globulin
Prealbumin
5 - 8 gm/100 ml
(9)
THYROID HORMONES SYNTHESIS BY FOLLICLE EPITHELIAL CELL
iodine. It results from peroxidase enzyme system which is present in thyroid. The
tion of TSH, Most of the anti thyroid drugs are inhibitory to this step.
( 10 )
Formation of mono and di-iodotyrosines via oxidation and organic binding of
structure with two di-iodinated rings linked by other bridge. Concomitantly there
occurs a loss of alanine side chain from ring that ultimately contains phenolin hy-
sines are held in a peptide bond within the thyroglobulin molecule and for coupling
of two peptide bonds iodotyrosines require disruption of peptide bonds, thus sub-
stantial change in thyroglobulin structure. Lack of TSH and iodine deficiency im-
cleavage within the follicular cells, under stimulation of TSH follicular colloid enters
and T4 . These hormones then diffuse through the wall of the follicle and reach the
( 11 )
blood stream, where they are degraded by enzyme dehydrogenase and iodine
remains available as second pool of for renewed oxidation and organic binding .
ma, important ones are L-thyroxine (T4) , Leothyronines (T3) and reverse T3. Of
are bound in a firm, but reversible bond to several proteins, all of which are syn-
thesized in liver.
T3 is mainly bound to TBG and to a small extent albumin but not to TBPA.
T4 exist in plasma in bounded and free form. TBG is mainly responsible for trans-
port of T4 -(77%) and 0.03% is found in free form. T3 has low affinity for TBG and
Exact site of their peripheral breakdown is not known but they are metabo-
lised by de-iodinase enzyme and liberated iodides return to iodide pool. 80% of
( 12 )
Excretion occurs via biliary route (25% faecal excretion), through urine and
about 10% with half life of 6-7 days while daily turnover of T3 and rT3 is 60%.
T4 8000 1 60
T3 120 25 30
rT3 25 120 30
3, 3T2 - 600 -
tons secreted by the anterior pituitary gland. TSH contains two non identical sub-
units termed as α and β. α subunits are similar in structure but β subunits differ
markedly in amino acid sequences and are responsible for biological specificity of
( 13 )
serum concentrations of T4 and T3 as well as other less well defined mechan-
isms.
and pituitary in a classic type of feedback control. In addition, intrinsic auto regula-
iodine and rate of hormone production. These two controlling systems play role in
thyroid regulation.
1. Hypothalamo-pituitary-thyroid complex.
( 14 )
A potential role of sympathetic nervous system in regulation of thyroid hor-
mone function was recognized many years ago. Nerves originating from cervical
ganglia and vagus nerve terminate within the thyroid, both vascular and nonvas-
Catecholamines via β2 receptor exert no effect in animals with intact TSH secre-
tion but following suppression of it, increase thryoid hormone secretion. Thus phy-
specific receptor sites at nuclear chromatin. This increases protein and enzymes
1. Calorigenic action
Stimulates oxygen consumption and heat production in all tissues. After thy-
(2) Growth
( 15 )
Thyroid hormones are essential for intrauterine as well extrauterine growth
and tissue differentiation. Intra uterine deficiency leads to cretinism while extra
(a) In physiological doses they are anabolic and stimulates protein syn-
(b) They increase the glucose absorption from the gut, rate of its intracel-
(c ) They increase the rate of cholesterol synthesis in the liver, rate of its
ism respectively.
( 16 )
(7) Reproductive tract and breasts
(10) Miscellaneous
involved in their synthesis, secretion and metabolism indicate that many factors
1. Endogenous variables.
2. Pharmacological agents
3. Environmental alterations
( 17 )
4. Dysfunction and diseases of other organ system.
Age
Environmental temperature
Nutritional influence
blood loss.
This present study has been undertaken to evaluate the thyroid function in
and its disease p405 New York John Wiley and Sons (1975)], and hypothyroidism
affects reproductive system in women more than in men, thyroid function studies
practice.
HUMAN STUDIES
roidism developing during foetal life does not appear to affect the normal devel-
Sexual Development
( 19 )
Kunde et al (1980) have reported precocious menstruation and galactorr-
trial stimulation with vaginal bleeding. Prolactin levels are usually elevated leading
androgen precursors so that axillary and public hairs are not apparent. Therapy
ogy.
amount of bleeding, some patients also present with amenorrhoea and galactorr-
hoea.
Gardner Hill and Smith (1927) and Lerman (1950) independently reported
biopsy in 10 patients with primary myxoedema and found that 5 had metropathia
( 20 )
showed proliferative endometrium which reversed to secretory after starting the
treatment.
al 1958).
and restoration of normal menstrual cycle followed the oral administration of des-
sicated thyroid.
Reis and Decosta (1961) expressed the opinion that myxoedema does not
result in typical aberration of menstrual cycle and stated that bleeding may be ex-
dilatation and curettage of uterus but in no instance malignant disease was found.
from India. Mukherji and Ghosh (1984) reported low serum thyroxin (T 4) and
( 21 )
tri-iodothyronine (T3) levels and normal levels of serum thyroid stimulating
Menstrual and reproductive history of 178 women referred to the thyroid clinic
ha, D Balaiah, R Shah (1993) Only 31.8% of hypothyroid women had normal
menstrual pattern in contrast with 87.8% of healthy controls (p < 0.001). The
16.67%.
, Col MM Arora, Lt Col HS Batra, Lt Col AK Harith and V Ambade (2007), menorr-
HYPOTHYROIDISM
results into increased formation of estriol. This altered oestrogen may result in ab-
normal feedback at the pituitary level with aberrant release of gonadotrophins re-
( 22 )
sulting in chronic anovulation along with excessive unopposed action of estrogen
for hyper secretion of TSH and PRL which lead to anovulation and menstrual irre-
norrhagia is common. This may result from chronic unopposed oestrogenic stimu-
Contreras et al (1981) have demonstrated loss of usual PRL rise after ad-
count for loss of dopaminergic inhibitory influence on PRL, TSH and LH. This
HYPERTHYROIDISM
( 23 )
antithyroid drugs. Ross et al (1958) reported successful treatment of severe me-
and did not reappear in1 to 3 years follow up in all patients of early hypothyroidism
( 24 )
MATERIAL AND METHODS
This study was carried out in 50 patients selected from OPD/IPD in De-
SELECTION OF CASES
In our series both outdoor admitted patients were included. These patients
1 Menorrhagia
2 Menometrorrhagia
3 Intermenstrual spotting
4 Polymenorrhoea
from the present study. Age of the patient varied between 20-40 years.
CLINICAL EXAMINATION
menarche, menstrual pattern both present and past, obstetric history, age of last
child birth, an attempt was made to obtain history suggestive of endocrine dys-
( 25 )
GENERAL AND SYSTEMIC EXAMINATION
The general body built, height, weight, pulse, BP respiratory rate, pallor, ic-
domen were thoroughly examined. The thyroid gland was examined for any ab-
normality.
GYNAECOLOGICAL EXAMINATION
Complete gynaecological examination (P/S and P/V) was done with the
help of female resident doctors to rule out any organic gynaecological disorder.
2. Cervix:
a. Hypertrophy
b. Congestion
c. Discharge
d. Direction
e. Erosion
P/V:- 1. Uterus
a. Size - Normal
( 26 )
Bulky (more than normal but not 6 > wks. enlarged multiparous
size)
b. Consistency of uterus
c. Direction of uterus
d. Mobility of uterus
e. Tenderness of uterus
2. Fornices
a. Tender/Nontender
INVESTIGATIONS
DIAGNOSTIC CRITERIA
rectomy had been done for dysfunctional uterine bleeding, were selected and
timation.
INCLUSION CRITERIA
( 27 )
Multipara women having menstrual irregularities between 20-40 years
The patient in whom hysterectomy had been done for dysfunctional ute-
rine bleeding, were also included in study after analyzing their previous
medical records.
EXCLUSION CRITERIA
found.
Patients, in whom hysterectomy had been done for reasons, other than
therapy in past.
( 28 )
Patient who were taking drugs which might cause abnormal results on
GROUING OF PATIENTS
Age group in all the cases ranged between 20-40 yrs. (child bearing age).
Menometrorrhagia.
medical techniques. Kit was used with serum samples without additives. Speci-
mens were capped and stored for up to 48 hours at 2-8°C prior to assay.
( 29 )
Principle of the test
gated with horseradish peroxidase are added to the microtiter wells. During incu-
bation, T4 and conjugated T4 compete for the limited binding sites on the anti- T4
antibody. After 60 minutes incubation at room temperature, the wells are washed
ed and incubated for 20 minutes, resulting in the development of blue color. The
color development is stopped with the addition of 2 N HCl, and the absorbance is
assayed in the same way, the concentration of T4 in the unknown sample is quan-
tified.
( 30 )
Stop Solution, 12 ml.
Distilled water.
Graph paper.
1. Unopened test kits were stored at 2-8°C upon receipt and the microtiter
damp air. The test kit might be used throughout the expiration date of the kit
measurement.
Reagent preparation
1. All reagents were brought to room temperature (18 - 22°C) before use.
( 31 )
Assay procedures
1. Desired number of coated wells were secured in the Holder and data sheet
wells.
6. The incubation mixture was removed by flicking plate contents into a waste
container.
7. The microtiter wells were rinsed and flicked 5 times with running tap water.
8. The wells were stroke sharply onto absorbent to remove all residual water
droplets.
9. 100μl of TMB solution was dispensed into each well and Gently mixed for 5
seconds.
11. By adding 100μl of Stop Solution to each well the reaction was stopped.
12. Optical density at 450nm was read with a microtiter well reader.
Calculation of results
1. The average absorbance values (A450) for each set of reference stan-
( 32 )
2. A standard curve was constructed by plotting the mean absorbance ob-
tained for each reference standard against its concentration in μg/dl on li-
near graph paper, with absorbance on the vertical (y) axis and concentra-
3. Using the mean absorbance value for each sample, the corresponding con-
Results of typical standard run with optical density reading at 450nm shown
.
T4 (μg/dl) Absorbance (450nm)
0 3.217
1 2.465
2.5 1.961
5 1.331
15 0.746
30 0.436
( 33 )
12
10
OD 4
0
0 10 20 30 40
T4 concentration (microg/dl)
Normal range was 5.0 to 13.0 μg/dl. The minimum detectable concentration
ESTIMATION OF TSH
sensitivity and specificity. The wells are coated with a monoclonal antibody di-
rected against a unique antigenic site on the TSH molecule. The microtiter strips
are incubated with patient samples and enzyme conjugate, which is a horseradish
determinant of the TSH molecule. The amount of immune complexes bound to the
wells is in proportion to the TSH concentration in the samples. After washing off
( 34 )
the unbound serum proteins and conjugate molecules, the strips are incubated
with chromogen solution and a blue colour develops in proportion to the amount of
REAGENTS
(96 wells).
agents (5 ml).
1. A microtiterplate reader.
2. Precision micropipettes with tips for 50 μl, 100 μl and 1000 μl.
ASSAY PROCEDURE
General remarks
( 35 )
1. All reagents and specimens were allowed to come to room temperature be-
3. All reagents and samples were pipetted onto the bottom of the well.
within 3 minutes.
Procedure
1. Desired number of coated wells were secured in the holder and data sheet
( 36 )
10. The absorbance of each well was determined at 450 nm within 30 minutes
following step 9.
RESULTS
nm was used. The TSH value of each patient was obtained as follows :
1. The average absorbance values obtained for each reference standard (or-
dinate) was plotted against the TSH concentration (abcis) and the best cali-
2. The average absorbance of each patient sample was used to determine the
REFERENCE RANGE.
( 37 )
OBSERVATIONS
The material for the present study comprised of 50 patients with various
1. Menorrhagia (Group A) - 20
2. Menometrorrhagia (Group B) - 15
3. Polymenorrhoea (Group C) - 10
AGE DISTRIBUTION
A 20 31.3 + 5.59 20 – 38
B 15 32.13 + 3.44 25 – 36
C 10 32.7+ 4.78 22 – 40
D 5 35.6 + 0.49 35 – 36
( 38 )
TABLE 2 : Age of Menarche in various groups
A 10.69 + 2.05 11 – 14
B 12.80 + 0.68 12 – 14
C 12.50 + 0.71 12 – 14
D 12.20 + 0.84 11 – 13
The age of menarche in all the groups were similar to one another (Table
2).
(n = 20)
Present Past
Range 7 – 12 3–5
Range 25 – 32 25 – 30
p < 0.02
( 39 )
AMOUNT OF MENSTRUAL FLOW
20
15
NUMBER
10
0
A B C D
GROUPS
ADEQUATE INCREASED
10
9
8
7
6
DAYS
5
4
3
2
1
0
A GROUPS B C D
PRESENT PAST
( 40 )
Table 3: shows the pattern of menstrual cycle in group A. The duration of
+ SD 8.85 + 1.07 days, Range 7 - 12, Past 3.95 + 1.10 days, Range 3 - 5 days
p < 0.02). yet, the duration of menstrual cycle was not significantly altered
(n = 15)
Present Past
Range 25 – 30 28 – 35
(Present : M + SD 7.36 + 1.1 days, Range 5 - 9, Past 3.0 + 0.85 days, Range 2
- 5 days p < 0.01). The menstrual flow was markedly increased in all the sub-
( 41 )
TABLE 5 : Menstrual Pattern in Group C (Polymenorrhoea)
(n = 10)
Present Past
Flow Increased 9 0
Normal 1 10
17.5 + 2.64 days, Range 15 - 20, Past 30.2 + 1.14 days, Range 28 - 30 days p
< 0.01). The flow was increased in 9 patients (90%) while it remained normal in
( 42 )
(n = 5)
Present Past
Range 28 – 30 30 – 35
Flow Increased 1 0
Adequate 4 5
spotting
Range 3–5 -
The duration of flow and duration of cycle were not significantly altered but all of
( 43 )
TABLE 7 : Present Menstrual pattern in various groups.
Menstrual Groups
Pattern
A (20)* B (15)* C (10)* D (5)*
Duration of M 8.85 7.36 5.5 5.2
flow (days)
S.D. 1.07 1.1 1.27 1.10
Range 7 - 12 5–9 56 - 9 4–7
Duration of M 29.3 27.6 17.5 29.2
Cycle
S.D. 1.72 7.22 2.64 1.10
Range 25 - 32 25 – 30 15 - 20 28 – 30
Amount of Adequate NIL NIL 1 4
Flow
Increased 20 15 9 1
Diminished NIL NIL NIL NIL
Pain + 7 6 7 2
Clots + 12 4 8 1
* p < 0.05, ** p > 0.05
groups.
The statistical analysis reveals that the duration of flow was significantly in-
previous values(p<0.05). In other groups (group C&D),the flow was not significant-
compared to their previous values (p<0.05) and the other groups (group A,B &D)
(p<0.05),while in others (groups A, B & D) the duration of cycle was not signifi-
( 44 )
The amount of flow was increased in all the patients in group A and B, 9 pa-
tients (90%) in group C and 1 patient (20%) in group D.A good proportion of pa-
OBSTETRICAL PROFILE
The analysis of obstetrical pattern in all the groups revealed that the gravi-
da, parity, no. of abortions, number of abnormal labours and the last child birth
( 45 )
CLINICAL GENERAL
Group
N Hb% Pallor Edema
(mean)
A 20 9.25 19 Nil
B 15 10.00 9 1
C 10 9.45 9 1
D 5 10.50 4 2
None of the patients had history of post partum haemorrhage and failure to
menstruate following delivery. History of lactation was present following the deli-
very in all the subjects. In none of subject, there was a history of headache, vomit-
ing and visual deficit (suggestive of pituitary tumour), pain in thyroid region (sug-
All the patients had no history of edema over body, cold intolerance, consti-
pations, dry skin, hoarseness of voice, decreased appetite and dyspnoea. Exami-
nation revealed that all the patients and controls were clinically euthyroid accord-
ing to Wayne’s index and had no goitre. However, pallor was present in majority
( 46 )
Clinical Gynaecological examination (per vaginum and per speculum) was
performed in all the patients. The findings on gynaecological examination are ta-
HAEMOGLOBIN STATUS
Investigations revealed that blood haemoglobins level were lower in all the
patients.
THYROID FUNCTIONS
( 47 )
Table12: shows thyroid functions among patients of Group A. One pa-
SD 2.12 4.77
( 48 )
SCATTER DIAGRAM OF GROUP A (MENORRHAGIA)
14
12
SERUM THYROXINE
10
(microg/dl)
8
6
4
2
0
0 5 10 15 20 25
n=20
30
25
SERUM TSH LEVEL (microIU/dl
20
15
10
0
0 5 10 15 20 25
n=20
( 49 )
Group T4 TSH ( Elevated Decreased %
A (n = ( g/dl) IU/ml)
20)
SD 1.99 3.41
Table13: shows thyroid functions among Group B patients showing one pa-
tient with elevated serum TSH level. This shows 6.5% incidence of primary hypo-
( 50 )
SCATTER DIAGRAM OF GROUP B (MENOMETRORRHAGIA)
16
THYROXINE(microg/dl))
14
12
10
SERUM
8
6
4
2
0
0 2 4 6 8 10 12 14 16
n=15
16
SERUM TSH (microIU/dl)
14
12
10
8
6
4
2
0
0 2 4 6 8 10 12 14 16
n=15
SD 1.17 0.71
( 51 )
Table 14 :shows the result of thyroid functions of group C patients patients in this
8
(MICROG/DL)
7
6
5
4
3
2
1
0
0 2 4 6 8 10 12
n=10
4.5
SERUM TSH(microIU/dl)
4
3.5
3
2.5
2
1.5
1
0.5
0
0 2 4 6 8 10 12
n=10
TA-
SD 1.6 0.77
( 52 )
Table15: shows thyroid functions in group D patients. All patients in this
14
SERUM THYROXINE(microg/dl)
12
10
0
0 1 2 3 4 5 6
n=5
3.5
3
SERUM TSH (microIU/dl)
2.5
1.5
0.5
0
0 1 2 3 4 5 6
n=5
( 53 )
TABLE 16: Comparison of thyroid functions among group A, B, C and D
serum T4 levels in group D are comparatively higher than in group A, B, C and se-
rum TSH levels in this group are lower than group A, B, C. This difference in le-
( 54 )
DISCUSSIONS
tice resulting in need for repeated curettage and hysterectomy with its atten-
dant morbidity and mortality. Objective measurements have shown that mean
percentile).
ism), or local lesions of genital tract like endometrial hyperplasia, pelvic in-
strual blood loss and menstrual irregularities. Menorrhagia has been reported
in 32% of subjects with myxoedema (Means 1948) and in 32.4% (Wg Cdr S
that classic clinical manifestation may take months and years to appear (In-
( 55 )
gbar 1985). Furthermore menorrhagia may be the only presenting complain in
vided into 4 groups, according to menstrual pattern. The age of these subjects
past menstrual flow (p < 0.02, table 2) though the cycles were regular and
length of cycles were not significantly altered (p > 0.05). Group B (meno-
pared to past menstrual pattern (p < 0.01, table 3) with regular menstrual
cycles but unpredictable bleeding off and on. These subjects differed from
(Group A, B, C and D) revealed that the patients in group A and B had signifi-
< 0.05, Table 3 & 4). In group C and D the mean duration of flow was slightly
increased but it was not no significantly increased from the past (p > 0.05, Ta-
ble 7). The duration of menstrual cycle was significantly shorter in subjects
The volume of menstrual flow was increased in all the patients in group A and
Detailed clinical evaluation was carried out to rule out any obvious en-
deep tendon reflexes, cerebellar signs. None of these patients had evidence
all the patients were clinically euthyroid with score less than 19, there was no
( 57 )
Gynaecological examination were carried out by doing per speculum
and per vaginal examination to rule out any vaginal, cervical or uterine pathol-
tient groups.
two patients had low levels of serum thyroxine and high levels of serum TSH,
gia and the other had menometrorrhagia. In the rest of the patient groups Se-
( 58 )
TABLE 1A: Comparison of thyroid functions among group A, B, C and D
Group Serum Thyrox- Serum thyroid stimulat-
ine ( g/dl) ing hormone ( IU/ml)
cant difference (p > 0.05, Table IA). Thus the prevalence of hypothyroidism in
( 59 )
SERUM THYROXINE AND TSH IN
VARIOUS GROUPS
10
9
8
7
6
TSH
5
4
3
2
1
0
A B C D
GROUPS
TABLE
( 60 )
Only few reports of thyroid functions in menstrual irregularities are
patients of menorrhagia had elevated serum TSH levels but they had subnor-
mal T4 and T3 levels. The finding of low T3 and T4 in the presence of low TSH
tients were not investigated further and there was not any mention of accom-
panying systemic illness like severe anaemia which can lead to sick euthyroid
syndrome in which the patients are clinically and metabolically euthyroid. 8 pa-
( 61 )
thyroxine and tri-iodothyronine levels were normal in all the patients. 15 out of
was 16.67%.
tion in oestrogen metabolism and its neurohypophyseal control has not being
fully elucidated. Gorden et al (1977) had reported increased rate of 16-α- hy-
( 62 )
droxylation of estradiol resulting into increased formation of estriol, this altered
ing into aberrant release of gonadotropins and chronic anovulation. This ex-
mus. This accounts for loss of dopamine inhibitory influence on PRL, TSH &
ism in India and it may be questioned whether this could have contributed to
absence of goiter in our patients and free availability of ionized salts in this
part of the country. However, urinary iodine excretion measurements are re-
( 63 )
Serum TSH response to TRH test can diagnose patent primary hypothyroidism
may have been higher if we had performed this test. We could not carry out this
( 64 )
DISTRIBUTION OF PATIENTS ACCORDING TO THEIR TSH
VALUES
14
12
DISTRIBUTION OF PATIENTS
10
0
<0.4 TSH 0.4 - 3 3.0 - 6.1 6.1 - 10 >10
HYPOTHYROIDISM %
7
6
FREQUENCY
5
4
3
2
1
0
A B C D
GROUPS
( 65 )
At present normal TSH range is 0.4-6.0 IU/ml, recently American clini-
from present 0.4-6.0 to 0.3-3.0 IU/ml as 95%of normal population fall in this
group, moreover 20 years follow up of the patients having TSH more than 3.0
IU/ml showed that majority of them converted to hypothyroid status later on.
be out of range of normal, 4% will have hypothyroid status and 20% sub-
( 66 )
SUMMARY & CONCLUSION
menstrual irregularity.
these patients were clinically evaluated in detail for any gynecological or clini-
were clinically euthyroid as judged by Wayne’s index and had no goiter or any
( 67 )
(1) Mean serum T4 and TSH levels in group A were 7.52 + 2.12 g/dl
(range 3.6-12.5 g/dl) and 3.7 + 4.77 IU/ml (1.0-24 IU/ml),one patient
(2) The mean serum T4 and TSH levels in group B were 7.28 + 1.99 /dl
(range 2.1-10.5 /dl) and 2.97 + 3.41 IU/ml (range 0.8-15.2 /ml). One
low T4 (2.1 g/dl) and high serum TSH levels (15.2 UI/ml).
strual spotting) had normal serum thyroxine and TSH levels (group C :
(5) All the patients of polymenorrhea and intermenstrual spotting were eu-
thyroid.
( 68 )
medical management and it is well known that these patients respond dramat-
that normal range of TSH should be narrowed from present 0.4 - 6.0 to 0.3 -
3.0 IU/ml as 95%of normal population fall in this group, moreover 20 years
follow up of the patients having TSH more than 3.0 IU/ml showed that majori-
Similarly in our study if we follow reference range of TSH 0.3 -3.0, 24%
if no organic cause is found, thyroid function test should be done and a close
( 69 )
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