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Eff ect of thyroid disorder on female
Noor Ibrahim Hasan – Samarra University / College of Applied Sciences
Abst ract :Women are more likely than men to have thyroid disease. One in eight wo men will develo p
thyro id problems during her lif etime. T hyroid hormones interact with reproduct ive ho rmones , es t rogens and
pro gestero ne, t o preserve normal f unctio n of the o varies and maturation of the egg (oo cyt e). If the thyroid
gland releases o f to o much (hypert hyro idis m) o r to o lit t le (hypo thyro idism) t hyroid hormones , the balance of
reproduct ive hormones can be impaired with cons ecutive thyro id-relat ed f ertilit y problems s uch as ovulat io n
disorders, irregular periods , and t ro uble getting pregnant o r carrying a baby t o term. Since t hyro id disease is
a co mmon endocrine dis o rder in wo men o f childbearing age, the firs t thing to do when you have t roubles
get t ing pregnant is to have yo ur t hyroid checked, especially if thyro id diseas e runs in yo ur f amily.
Problems with menst rual perio d: thyroid helps contro l the mens t rual cycle. Too much or to o little
thyro id hormo ne can make the periods very light, heavy, or irregular. T hyro id diseas e also can cause the
perio ds to s t o p f or s everal months o r longer, a co ndition called amenorrhea. If t he bo dy's immune s ys t em
caus es thyro id disease, other glands , including t he ovaries , may be involved. T his can lead to early
menopaus e (bef ore age 40).
Problems getting pregnant : When thyro id disease af fects the menstrual cycle, it also af fect s
ovulat io n. This can make it harder f or wo man to get pregnant .
Problems during pregnancy : Thyroid problems during pregnancy can cause health problems f o r the
mot her and t he baby.
Intro duction : T he t hyroid gland regulates the body's metabo lism and growth, and secretes several
hormones : t hyroxine (T 4), triio dothyro nine (T3), and calcito nin. T hyroid problems can af fect f emale pat ients
of any age. It is lo cat ed in t he f ront lower part o f the neck. Hormones releas ed by t he gland t ravel t hrough
the bloo ds t ream and af f ect nearly every part of t he body, f rom t he heart and brain, to the muscles and
skin. T he f unctio ns o f the t hyro id gland have much t o do wit h a wo man's repro ductive
system, particularly if the thyroid is o veractive or underactive. Ef fect s of this imbalance in hormone levels
may have t he f ollo wing ef f ects on a woman's bo dy:
The overactive t hyroid “hyperthyro idism”
Hypert hyroidis m is a diso rder in which your thyroid gland makes and releases more t hyroid hormone
than your bo dy needs. Your do cto r may s ay yo u have an "o veract ive t hyroid," or ref er to t he co nditio n as
"overactive t hyroid dis ease."
Thyro id gland is located in t he f ro nt of yo ur neck. Ho rmo nes released by the thyroid af f ect nearly
every part of your bo dy f rom yo ur brain to your skin and muscles. T hey play a crucial ro le in co nt rolling ho w
your bo dy us es energy, a pro ces s called metabo lism. T his includes ho w your heart beats and even ho w yo u
burn calo ries.
Women are f ive to 10 t imes more likely to develop hypert hyro idis m than men.
T he caus es of hypert hyroidism include:
Graves ' diseas e : the mos t co mmon cause o f hypert hyro idis m is an aut o immune condit io n called
Graves ' dis ease. T he body's immune sys t em creat es an antibo dy that causes t he gland to make an
exces s ive amount o f thyro id hormone. Graves' disease runs in f amilies, and us ually af fect s yo unger wo men.
Thyro iditis: thyroidit is is inf lammatio n of the thyro id. A virus o r pro blem wit h the immune s ys t em causes
the gland t o swell, leaking thyroid ho rmone int o the blo ods t ream. There are s everal type s o f Thyro idit is .
Subacut e: a sudden, painf ul f orm o f Thyro idit is of unknown cause. T he thyroid usually heals on its
own af ter a f ew mont hs. The thyroid can beco me underactive f or a while bef ore it ret urns t o normal.
Pos t part um: t his type o f T hyro idit is af fects wo men af ter pregnancy. One t o two wo men o ut o f every
10 women develop hyperthyroidism af ter having a baby. It us ually lasts a mont h or t wo , f ollowed by s everal
mont hs of underactive t hyro id (hypo t hyroidism). In most wo men, t he t hyroid returns to no rmal.
Silent: this type is s imilar t o postpartum Thyro iditis but is not relat ed to pregnancy. The thyro id
pro duces too much ho rmo ne but pat ients do not develo p a painf ul thyro id gland. Some people may develo p
hypo t hyro idis m af terwards.
Thyro id nodule: one o r more lumps, or no dules, can grow in t he thyro id gland, gradually increas ing t he
gland's act ivit y and t he amount o f thyroid ho rmone in yo ur blood.
If one no dule caus es hyperthyroidism, it is called a single t oxic no dule.
If several nodules cause t he thyroid to become overactive, the condition is called t o xic multino dular
goiter.
Excess iodine: you may also develop hypert hyro idis m if you eat, drink, or are o therwise exposed to
substances t hat co nt ain a high amount o f iodine. Io dine is used by the bo dy to make thyro id hormone. Kelp
or seaweed supplements and the medicat io n amiodaro ne (Cordarone, Pacero ne), o nce us ed t o treat
irregular heartbeat s , are examples o f medicines that co ntain a lot of iodine.
Thyro id medicat io ns: taking to o much thyro id hormone medicatio n can wreak havoc on your thyroid
gland and cause hypert hyro idis m. If you have been pres cribed thyro id replacement ho rmone (f or
hypo t hyro idis m), never take an ext ra do s e, even if you missed o ne, without f irst t alking to yo ur do cto r.
Sympto ms o f hyperthyroidism may be vague and can o ften mimic o t her illnesses and condit io ns. If you
have a very mild f o rm of hypert hyroidism, you may no t no t ice any s ympt o ms. Symptoms are of ten part icularly
subtle in the elderly. However, an overactive t hyroid o ften leads t o disco mf ort or even disability t hat dis rupt s
your everyday act ivit ies or routines .
Thyro id enlargement , called a goiter, occurs in most peo ple wit h hyperthyro idism. You may see o r f eel
a lump in t he f ront o f your neck. Sometimes only yo ur do cto r will be able to detect a goiter.
Other symptoms o f hypert hyroidism include:
Anxiety, nervo us ness, and irritability
Frequent, lo o s e bowel movement s
Dif f iculty s leeping
Double visio n
Eyes that bulge o ut, o r "protrude" (in pat ients with Graves ' diseas e)
Hair changes , including brit t le hair, thinning hair, and hair loss f rom scalp
Irregular heart beat (arrhyt hmia), especially in older adult s
Menst rual cycle changes , including light er bleeding and les s f requent perio ds
Muscle weakness, especially in t he thighs and upper arms
Rapid f ingernail growth
Rapid heart beat , usually o ver 100 beats per minute
Shaky hands
Sweating
Thinning s kin
Weight lo s s despit e increased appet it e
The underact ive thyro id “hypothyro idism”
Hypothyro idism, als o called underactive thyroid diseas e, is a co mmon disorder. With hypothyroidism,
your t hyroid gland do es not make enough thyroid ho rmone.
The most common caus e o f hypo t hyroidism is Hashimoto's thyroiditis. "Thyroiditis" is an inf lammatio n
of the thyroid gland. Hashimoto's t hyro idit is is an aut o immune diso rder. With Hashimoto ’s, yo ur bo dy
pro duces antibo dies that att ack and destro y the thyroid gland. Thyroidit is may also be caused by a viral
inf ect ion.
Other caus es of hypothyro idism include:
Radiatio n therapy to t he neck area: treat ing cert ain cancers, s uch as lympho ma, requires radiat io n to
the neck. Radiation damages t he cells in the thyro id. T his makes it more dif ficult f or the gland to pro duce
hormone.
Radioact ive io dine treat ment : t his t reat ment is co mmonly prescribed to peo ple who have an o veract ive
thyro id gland, a co nditio n known as hypert hyro idis m. Ho wever, radiatio n destro ys the cells in t he thyro id
gland. T his usually leads to hypothyroidism.
Use of certain medicat io ns: certain medicines t o t reat heart pro blems, ps ychiatric co nditions, and
cancer can s o met imes aff ect t he product io n of thyroid hormone. T hese include amiodaro ne (Cordaro ne),
lithium, interf eron alpha, and int erleukin- 2.
Thyro id surgery : surgery t o remove t he t hyroid will lead t o hypothyroidism. If only part o f the thyroid is
removed, the remaining gland may s t ill be able to pro duce eno ugh hormone f or t he bo dy's needs .
Too little io dine in the diet: t he t hyro id needs io dine to produce thyroid hormone. Your body do esn't
make io dine, so yo u need t o get it t hrough your diet. Iodized t able salt is rich in iodine. Other f oo d s o urces
of iodine include shellf ish, s alt water f ish, eggs, dairy product s , and s eaweed.
Pregnancy : t he reas o n isn’t clear, but sometimes , inf lammation o f the t hyroid o ccurs af ter pregnancy.
This is called pos t part um t hyroidit is. Wo men with this condit io n us ually have a s evere increase in t hyro id
hormone levels f ollo wed by a sharp dro p in thyroid hormone pro ductio n. Most women with postpartum
thyro iditis will regain their no rmal t hyro id f unctio n.
Problems with the thyro id at birth: s o me babies may be bo rn with a t hyroid gland that did no t develo p
correctly o r do es no t work pro perly. This t ype o f hypothyroidism is called co ngenit al hypothyro idism. Mos t
hospit als in the U.S. screen babies at birth f or t his diseas e.
Pituit ary gland damage or disorder: rarely, a problem with the pituit ary gland can interf ere with the
pro duction of thyro id ho rmone. The pituit ary gland makes a ho rmone, called thyro id- stimulating hormone
(T SH), which t ells yo ur thyro id ho w much hormone it s hould make and releas e.
Diso rder o f the hypo t halamus: an extremely rare f orm o f hypo t hyroidism can o ccur if the hypothalamus
in the brain do es not produce eno ugh of a hormone called T RH. T RH af fect s t he release o f T SH f rom the
pituitary gland.
Primary hypo thyro idism is caused by a pro blem with the t hyroid gland it s elf .
Secondary hypothyro idism occurs when ano ther problem int erf eres wit h the thyro id's ability to pro duce
hormones . For example, the pit uit ary gland and hypo thalamus produce hormones that t rigger t he release o f
thyro id ho rmo ne. A problem with o ne of these glands can make your thyro id underactive.
Sometimes, an underact ive t hyro id that results f rom a pro blem with the hypothalamus is called tert iary
hypo t hyro idis m.
Women, part icularly older women, are more likely to develop hypothyroidism t han men. You are also
more likely t o develop hypo t hyro idis m if yo u have a clo s e f amily member wit h an aut o immune disease. Ot her
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risk f acto rs include:
Race (being white o r Asian)
Age (growing older)
Prematurely graying hair
Auto immune diso rders such as type 1 diabet es , multiple sclero sis, rheumato id art hritis, celiac diseas e,
Addison's diseas e, pernicious anemia, or vit iligo
Bipolar diso rder
Down syndro me
Turner s yndro me
Sympto ms of hypot hyroidism may be vague and can of ten mimic o t her co nditions. They may include:
Changes in t he menstrual cycle
Constipat io n
Depression
Dry hair and hair loss
Dry skin
Fatigue
Greater s ensitivity to co ld
Slow heart rat e
Swelling o f the t hyroid gland (goiter)
Unexplained weight gain o r dif ficulty lo s ing weight
Carpal tunnel syndrome
Complications o f Hypot hyroidis m
Untreated, hypo t hyroidism may caus e:
Heart pro blems
Inf ert ilit y
Joint pain
Obes it y
Thyro id problems in a pregnant woman can af f ect the developing baby. During t he f irst three mont hs
of pregnancy, the baby receives all t hyroid ho rmone f rom its mot her. If the mother has hypothyroidism, t he
baby does no t get enough t hyro id hormone. T his can lead to problems with ment al develo pment.
Extremely low levels o f thyro id hormone can caus e a lif e-t hreatening condition called myxedema.
Myxedema is the most s evere f orm o f hypo t hyroidism. A perso n wit h myxedema can lo s e co nsciousnes s o r
go int o a co ma. The co nditio n can also cause the body t emperature to drop very lo w, which can cause death.
Hypert hyro idis m Diagnosis
Bloo d t es t s can conf irm a diagno s is of hypert hyroidism. Bloo d tests include those f o r t hyro id-
stimulating hormone (TSH). T his is a hormone releas ed by t he pituitary gland to st imulat e the thyroid to
make thyro id hormone. Other blood t ests include measures of thyroid ho rmone levels (t ypically elevated) and
thyro id-stimulating ant ibody (called thyro id-stimulating immunoglobulin t es t ) to check f or Graves' diseas e. If
your t est results are abnormal, yo ur do ct or may also order t he f ollo wing tes t s :
Thyroid ult rasound to check f or no dules or inf lammatio n
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Radio act ive iodine upt ake tes t t o see yo ur t hyroid absorpt io n of iodine
Thyroid scan to see where iodine is in the thyro id
There are several diff erent ways to treat hypert hyro idis m. Bef ore choo s ing the one that 's best for
you, yo ur docto r will consider yo ur age, o verall heath, s everit y o f yo ur symptoms, and specif ic cause o f your
overactive t hyroid.
Treatment o pt io ns include:
Anti- thyro id drugs . Thes e medicat io ns, including propylthiouracil (PTU) and methimazole (Tapaz o le),
help prevent the t hyroid gland f rom making new hormone. This does n't permanently damage the thyroid, but
some peo ple may have serio us side ef fects.
Radioact ive iodine (RAI) t aken by mouth. Overactive t hyro id cells quickly absorb this io dine and soo n
die. This prevent s the release of t hyro id hormone. Any remaining radioact ive iodine disappears f ro m the
body wit hin a f ew days. It may t ake a f ew months f or the therapy t o relieve hypert hyro idis m symptoms, and a
second do s e may be needed. Peo ple who have this t reat ment will develo p an underact ive thyro id
(hypo thyroidism), and will need thyro id ho rmone s upplement s f or the rest o f their lif e. T his t herapy cannot
be done during pregnancy.
Surgery to remove all o r part o f the thyro id, called a thyro idectomy. Most peo ple who have t his
pro cedure eventually develop an underactive thyro id and will need to take thyroid hormone- replacement
medication f or t he rest of their lif e.
Beta- blo ckers t o slo w down your heart rat e. These medicines do not lower your thyro id ho rmo ne levels
but help relieve s ympto ms relat ed t o a rapid heart rate.
Aft er t reat ment , you will need regular blood tes t s to check yo ur t hyro id hormone levels. Your doct or
may need to adjust your medication dose f rom time t o t ime.
Complications o f Hyperthyro idism
It is import ant to maintain regular, lif elong visits with your do ct o r if you have hyperthyroidism.
Untreated o r impro perly t reated, an o veract ive thyro id can lead to severe, even lif e-threatening problems.
Complications linked to hypert hyro idis m include:
Irregular heart rhythm (at rial f ibrillation)
Conges t ive heart f ailure
Miscarriage
Ost eopo ros is and bone fract ures (hyperthyro idism causes your bones to lose calcium fas t er than
usual)
Thyro toxic crisis is a s udden wo rs ening of hypert hyro idis m s ympto ms that can be deadly if not treated
right away. Seek immediate medical help if you or someone yo u know has hyperthyro idism and develops the
f o llowing s ympt o ms:
Agitation o r signs o f delirium
Co nf usio n
Decreased awareness
Fever
Restlessnes s
Very f ast pulse
Thyroid disease in pregnancy can af fect the health of the mother as well as the child bef ore and
af ter delivery. T hyro id dis o rders are prevalent in women o f child-bearing age and f or t his reas o n co mmonly
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pres ent as an intercurrent disease in pregnancy and the puerperium.[1] Unco rrect ed thyroid dysf unctio n in
pregnancy has advers e ef fects on f etal and maternal well-being. The delet erious ef f ect s o f t hyro id
dysf unction can also extend beyond pregnancy and delivery to aff ect neuro intellect ual development in the
early lif e of the child. Demand f o r thyro id hormones is increased during pregnancy which may cause a
previo usly unnoticed t hyroid dis o rder to wors en. Still, the o verall lack o f evidence precludes a
reco mmendat io n f or universal screening f or t hyro id disorder in all pregnant women
Ref ere nces
1. Clinical Practice Guideline. J Clin Endo crinol Metab 2012;
2. De Gro o t L, Abalovich M, Alexander EK, Amino N, Barbour L et al. Management of T hyro id
Dysf unct io n during Pregnancy and Po s t part um: An Endocrine Society
3. Green BB, Weiss NS, Daling JR. Risk of o vulatory inf ertility in relation to body weight. Fert ilit y and
Sterility
4. Healy DL, Tro unson AO, Andersen AN. Female inf ertility: causes and treatment. Lancet 1994 ; 343
5. Krass as GE, Poppe K, Glino er D (2010) T hyroid f unctio n and human repro ductive healt h. Endocr.Rev.
2010
6. Meikle AW. T he interrelat io nship between t hyro id dysf unctio n and hypogonadism in men and bo ys.
Thyroid 2004; 14 (Suppl 1): S17- S25.
7. Poppe, K, Glinoer D, To urnaye H et al. T hyro id f unctio n and ass is t ed repro duction. In: T he Thyro id
and Repro ductio n, METS Riga 2008. Georg T hieme Verlag
8. The Hormone Foundation’s Patient Guide t o t he Management o f Maternal Hypot hyro idis m Bef ore,
During, and Af t er Pregnancy. De Groo t LJ, Stagnaro - Green A,
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