DEPARTMENT OF PRASUTI

TANTRA EVAM STREE ROGA

welcomes you all

ROLE OF THYROID GLAND

IN REPRODUCTIVE

PHYSIOLOGY

By

Dr.Pooja Lekshmy P

1st Year PG Scholar

Dept Of PTSR

Guide

Dr.Gayathri Bhat NV

HOD ,Dept. Of PTSR

ContentsIntroduction

Anatomy

Physiology

Systemic action

Thyroid disorders

Ayurvedic aspect

Preventition

Critical analysis

Conclusion3

INTRODUCTION

Endocrine system - second key regulator of organ

systems

Thyroid gland – one of the largest endocrine gland

metabolism

growth

development.

Well functioning TG - pivotal for a healthy body & to

conceive a healthy child.4

5ANATOMY

6

Thyroid means “oblong

sheild.”

Brownish-red, butterfly

shaped structure - front of

the neck .

just inferior to larynx

from C5 to T1

Weight 25 gm./1 ounce

Each lobe - 5 x 3 x 2cm

Isthmus – 1.25cm x 1.25 cm x 1.25 cm.

Slightly heavier in females enlarging during

menstruation and pregnancy.

Highly vascular receiving 80-120ml of

blood\min.

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Microscopic anatomy

includes thyroid follicles -spherical.

0.02 to 0.9mm in diameter.

with a central colloid core surrounded by a

simple epithelium and basal lamina.

Colloid -thyroglobulin.

Parafollicular cells /“C”cells.

8

THYROID HORMONES

Thyroid gland – large storage capacity , store

thyroid hormone for 2 to 3 months.

Thyroid hormone include

1. 93% Thyroxine (t4) - 10-25pmol/ltr (normal)

2. 7 % Triiodothyronine(t3) - 1.1-2.3nmol/ltr

3. Thyrocalcitonin – parafollicular cells

Normal value - TSH - 0.45 -5.5mmol/ltr

T3 is about 4 times as potent as T4.

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10

P

H

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S

I

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L

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G

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P

H

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Control of Thyroid hormone

Secretion

Pic …

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SYSTEMIC ACTIONS

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Action of thyroid

hormones

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•Cells Metabolic activity

•CVS Cardiac output

•RS Respiratory rate

•GIT GI motility

•CNS Excitability of nerves

•CARBOHYDRATE METABOLISM

•FAT METABOLISM

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Females Males

T3 induced modulation

Estrogen metabolism

Sexual maturation

Menstrual function

Ovulation & Fertility

Develop full term infants

Stimulates production of

SHBG

TH receptors in Sertoli cells

Male reproductive tract

development

Maturation of testes (in

pre-natal and post-natal)

Maturation of sperm

(based on research work by National Institute of Environmental

Health Science by US Govt)

EFFECT ON REPRODUCTIVE

SYSTEM

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T3

T4

TB

G

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DEPENDS ON MOTHER

Iodine Con.,TSH Secr.

Pituitary thyroid system dev

TSH

T4 T3 remains Low

1ST

TRIMISTER

Till

term

12-14

WEEKS

8-10

WEEKS

20-28

WEEKS

T

H

Y

R

O

I

D

P

H

Y

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L

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Y

F

O

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T

U

S

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THYROID DISORDERS

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THYROID DISORDERS

Thyroid abnormalities – autoimmune, 10 times

more common in women than men.

21

Antigens

Thyroglobulin(Tg)

Thyroid

peroxidase(TPO)

TSH receptor(TSHR)

Na /I symporter(NIS)

Antibody

Antithyroglobulin(anti-tg)

Antimicrosomal thyroid

peroxidase (anti-TPO)

Anti-tsh receptor(anti-tshr)

Anti-na/I symporter(anti –

NIS)

Classification of thyroid disorders

Mainly into two divisions

Hyperthyroidism

Hypothyroidism

22

HYPERTHYROIDISM

23

Anti TSH-r

Present

Triad of

Symptoms

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H

Y

P

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T

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M

HYPERTHYROIDIS

M

TSH

T3&T4

Excessive Vomiting in Pregnancy

First-Trimester Miscarriage

Nervousness

Irritability

Difficulty Sleeping

Swelling (Goiter)

Frequent Bowel

Movements(diarrhoea)

Warm, Moist PalmsFine tremors

Hoarseness orDeepening of Voice

Difficulty Swallowing

Rapid or Irregular Heartbeat

Unexplained Weight Loss

Increased Sweating

PersistentSore or Dry Throat

CLASSICAL SYMPTOMS

25

26

Increased mean

plasma estrogen level.&LH

level .

Increased level of SHBG.

Increased incidence of

oligomenorrhea

amenorrhea & anovulation.

.

Increased estrogen

production.

Defective

spermatogenesis.

Low sperm count with

sperm motility defect.

Effect of Hyperthyroidism in Reproductive system

FEMALES MALES

Symptoms – lack of

menstruation, hot flushes,

insomnia, mood swings –

mistaken for menopausal

symptoms.

Treatment of hyperthyroidism –

alleviate symptoms of ,or the

actual onset of early

menopause.

27

May cause early onset of menopause

COMPLICATIONS IN PREGNANCY

Mild maternal tachycardia

heart murmur with irregular heart-beat.

Unexplained weight loss or failure to have normal

pregnancy weight gain.

Spontaneous abortion.

Pregnancy-induced hypertension.

Pre term delivery.

Anaemia.

Higher susceptibility to infections.

Placental abruption.

Post partum thyroid dysfunction.28

Transient hyperthyroidism in pregnancy

Thyroid activity increase in

conditions of

Molar pregnancy.

When hyperemesis gravidorum is

associated with high level of hCG

29

EFFECT ON FOETUSIntra uterine growth retardation.(IUGR)

Low birth weight.

Intrauterine foetal death.

Still birth.

Prematurity.

Skeletal developmental abnormalities.

Foetal-neonatal hyperthyroidism.(plancental transfer

of anti TSH- R).

Overtreatment with antithyroid drugs-foetal

goiter.30

TREATMENT OF

HYPERTHYROIDISM

Antithyroid drugs:

Methimazole : 10 -20 mg daily, once it is

controlled -5 -10 mg daily.

Propanol : 20-40 mg every 12 hr orally.

Surgical removal .

.31

HYPOTHYROIDISM

32

HYPOTHYROIDISM

33Tiredness

Forgetfulness/Slower Thinking

Irritability

Depression

Inability to Concentrate

Thinning Hair or Hair

Loss

Decreased libido

Dry, Patchy Skin

Weight Gain

Cold Intolerance

Elevated Cholesterol

Constipation

Infertility

Menstrual Irregularities/Heavy Period

Slower Heartbeat

Difficulty Swallowing

Persistent Dry orSore Throat

Hoarseness/Deepening of Voice

Swelling (Goiter)

Muscle Weakness or Cramps

ELEVATED SERUM LEVEL

OF TSH, LOWT3- T4

VALUE

Myxedema –bagginess under

eye and swelling of face.

Atherosclerosis

Slow and husky voice.

34

EFFECT ON REPRODUCTIVE

SYSTEM

35

Delay in onset of puberty with

anovulatory cycle.

Increased prolactin Level; GnRH

reduced

Diminished libido .

Recurrent miscarriage

Amenorrhea, oligomenorrhea,

galactorrhea – due to high prolactin

level

Incidence of infertility and PCOD

Testicular atrophy in men

Effects on pregnancy

High risk of pre-eclampsia ,often lead to premature

delivery .

Muscle cramps,constipation

Still birth ,low birth weight.

Placental abruption & PPH.

Associated with hypertension,type 1

diabetes,anaemia.

Increased risk of spontaneous abortion.

36

EFFECT ON FOETUS

Congenital abnormalities.

Delay in sexual maturity.

Lower IQ in infants of every mild hypothyroid

women.

CHILDREN: CRETINISM:

Congenital Hypothyroidism

Dwarfism

Mentally Subnormal: MR

Enlarged, Protruding tongue

Pot bellies.37

TREATMENT OF HYPOTHYROIDISM.

L- THYROXINE – to be given.

Brand name - Eltroxin

During pregnancy regular check up btw

every 4 week .

38

ELTROXINE

INVESTIGATIONS

THYROID FUNCTION TEST

Level of TSH, T3,T4 in blood sample.

Thyroid scan

FNAC

MISCELLANEOUS TEST

include serum cholesterol ,serum creatine

etc

39

INCIDENCE RATE.

42 million people in India – TD

Hypothyroidism –

congenital 1 out of 2640 children in India

1 out of 3800 children in World

Adult- 3.9%

Hyperthyroid

Adult -1.6% 40

Ayurvedic Perceptive

The “Hidden” Health Problem

Thyroid gland - AuÉOÒû

LMüÅuÉOÒû (cÉ.zÉ.7/11)

The goiter is termed as “galaganda”

xuÉÃmÉqÉç

ÌlÉoÉlkÉÈ µÉrÉjÉÑrÉïxrÉqÉÑwMüuÉiÉç sÉqoÉiÉå aÉsÉå ||

(xÉÑ.ÌlÉ11/29)

...

Prakupita kapha – situated at galabahya –shotha (

42

TYPES (xÉÑ.ÌlÉ11/23)Vataja - iÉÉåSÇ,M×üwhÉÍxÉUÉ AuÉlÉ®Ç

M×üwhÉÉÂhÉuÉhÉïÇ

AÌiÉÎxlÉakÉiÉUÇ(qÉåSÉåÎluÉiÉÇ),AÉxr

ÉuÉæUxrÉÇ .

Kaphaja -ÍcÉUÉiÉç mÉÉMÇü, qÉlS ÂeÉÇ,

EaÉëMühQÒû, qÉkÉÑUÉxrÉiuÉÇ.

Medojam -SåWûÉlÉÑÃmÉ

¤ÉrÉuÉ×ήrÉÑ£Çü lÉÏÂMçü,

AÌiÉMühQÒû

lÉ ÌmɨÉålÉ xuÉpÉÉuÉålÉ ÌmɨÉeÉxrÉ

aÉsÉaÉhQûxrÉ ApÉÉuÉÉiÉç || 43

CHIKITS

A Vataja Galaganda :

Nadi Swedam

Raktamokshanam

Upanaham

Pradeha

Taila panam with

Amritavalyadi yoga

Kaphaja Galagand

Swedana

Upanaham

Raktavisravanam

Magadhikadi siddha tailapanam

Vamanam

Nasya

Vairechanika Dhumapanam,

44

Medoja galagandam

Swedanam

Siravyadhanam

Sastrakarmam- avapaatanam

Sivanam

Agnikarma

Triphalakshaya panam

45

PATHYAS (Su.Chi.18)

Trikatu + Honey + gomutram

Yavannam

Mudgarasam

Shrungaveram

Patola

Nimba

Purana ghritha panam

46

Yoga:

Sarvangasna

Bhujangasanam

Chakrasanam

Arthamatsendriyasanam

Pavanmuktasana

Suptavajrasana and all backward bending

asanas.

Pranayam

PREVENTION - organ damage

unpleasant symptoms

negative consequences

Beejadushti

Srotho

vaigunya

ViprakrushtaHetu

48

Early detection

and proper

treatment

AVOID THE HETU

CRITICAL ANALYSIS

Vataja galaganda as per symptoms –Hyper

thyroidism

Kaphaja galaganda as per symptoms –

Hypothyroidism

In other sense hyperTh as Apatarpanotha

vyadhi/ and hypoth as santharpanotha vyadhi

Hence management can be adopted according

to the condition

49

CASE REPORT

y

50

Name X

Age 19yearsSymptoms Since

Presenting C/O Weight gain(7kg),

menorrhagia

3 months

History of

presenting

illness

thyroid nodules Birth

PCOD 3 years

Increased TSH 7 Years

Family History Mother - Hypothyroid

Treatment Tab Eltroxin 7 years

Investigation TSH level 12mmol/ltr

Diagnosis – Hypothyroid(Kaphaja Galagandam)

Treatments given

Kanchanara guggulu 2 Bd for 5 days

Varanadi kwatham 15ml Bd for 5 days

Panchakarma Treatment

Snehapanam with Satavaryadi

Ghritam(30,60,90,110ml)

Vamanam

Satavaryadi avaleha 1tsp Bd51

TSH after treatment 2.2mmol/ltr

Conclusion TD – Most

Undiagnosed,

overlooked,

overhidden disease.

Present medicinal

therapy – Inadequate

Further research – to

early diagnose and

treatment52

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