thyroid and fertility by dr. gayathiri
TRANSCRIPT
THYROID AND FERTILITY
THYROID AND FERTILITYDr. Gayathiri Ganesan RamMS(O.G), Fellow in Reproductive Medicine and Andrology.Consultant Infertility SpecialistARC fertility centre.
INTRODUCTIONIn normal humans, 0.03% of T4 and 0.3% of T3 in the circulation can be found as free hormones.
75% of T4 is transported as bound to thyroxin binding globuline (TBG), 20% to transtretine (TTR), 5% to albumin.
Schussler et al, Thyroid 2000:10:141-9.
HYPOTHYROIDISM
EPIDEMIOLOGY
The prevalence of hypothyroidism in women in the reproductive age (2040years) varies between 2% and 4%.
Clinical Endocrinology vol 66,pages 309321,March 2007
EPIDEMIOLOGY
Females > Males 8 : 1
Fortunately, hypothyroidism is very rare in males with an occurrence rate of only 0.1% in the general population [krassus et al]
Clinical Endocrinology vol 66,pages 309321,March 2007
EPIDEMIOLOGY
90 % of the cases are Primary Hypothyroidism
Clinical Endocrinology vol 66,pages 309321,March 2007
EPIDEMIOLOGY
Association between the severity of menstrual abnormalities and higher serum TSH levels
Clinical Endocrinology vol 66,pages 309321,March 2007
8MULTI SYSTEM EFFECTS - HYPOTHYROIDISMGeneralLethargy, SomnalenceWeight gain, GoitreCold Intolerence
CardiovascularBradycardia, AnginaCHF, Pericardial EffusionHyperlipIdemia, Xanthelsma
HaematologicalIron def. Anaemia, Normo cytic /chromic Anaemia
Reproductive systemInfertility, MenorrhagiaImpotence, Inc. Prolactin
NeuromuscularAches and painsMuscle stiffnessCarpel tunnel syndromeDeafness, HoarsenessCerebellar ataxiaDelayed DTR, MyotoniaDepression, Psychosis
Gastro-intestinalConstipation, Ileus, Ascites
DermatologicalDry flaky skin and hairMyxoedema, Malar flushesVitiligo, Carotenimia, Alopecia
HYPOTHYROIDISM AND FERTILITY Elevated TRH
+++ +++
>TSH >PROLACTIN
OVULATION