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