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Effect of thyroid disorder on female



:Women are more likely than men to have thyroid disease. One in eight women will develop thyroid problems during her lif etime. Thyroid hormones interact with reproductive hormones, estrogens and progesterone, to preserve normal f unction of the ovaries and maturation of the egg (oocyte). If the thyroid gland releases of too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormones, the balance of reproductive hormones can be impaired with consecutive thyroid-related f ertility problems such as ovulation disorders, irregular periods, and trouble getting pregnant or carrying a baby to term. Since thyroid disease is a common endocrine disorder in women of childbearing age, the f irst thing to do when you have troubles getting pregnant is to have your thyroid checked, especially if thyroid disease runs in your f amily. Problems with menstrual period: thyroid helps control the menstrual cycle. Too much or too little thyroid hormone can make the periods very light, heavy, or irregular. Thyroid disease also can cause the periods to stop f or several months or longer, a condition called amenorrhea. If the body's immune system causes thyroid disease, other glands, including the ovaries, may be involved. This can lead to early menopause (bef ore age 40). Problems getting pregnant : When thyroid disease af f ects the menstrual cycle, it also af f ects ovulation. This can make it harder f or woman to get pregnant. Problems during pregnancy : Thyroid problems during pregnancy can cause health problems f or the mother and the baby.
Eff ect of thyroid disorder on female
Noor Ibrahim HasanSamarra 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
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
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
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
Dry hair and hair loss
Dry skin
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
Ost eopo ros is and bone fract ures (hyperthyro idism causes your bones to lose calcium fas t er than
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
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
Евразийский научный журнал 5
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
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.
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.
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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,
Евразийский научный журнал6
ResearchGate has not been able to resolve any citations for this publication.
Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.
Thyroid hormone deficiency affects all tissues of the body, including multiple endocrine changes that alter growth hormone, corticotrophin, glucocorticoids, and gonadal function. Primary hypothyroidism is associated with hypogonadotropic hypogonadism, which is reversible with thyroid hormone replacement therapy. In male children follicle-stimulating hormone (FSH) is elevated and associated with testicular enlargement without virilization. Men with primary hypothyroidism have subnormal responses of luteinizing hormone (LH) to gonadotropin-releasing hormone (GnRH) administration and normal response to human chorionic gonadotropin (hCG). Free testosterone concentrations are reduced in men with primary hypothyroidism and thyroid hormone replacement normalizes free testosterone concentrations. In men with primary hypothyroidism, prolactin is not consistently elevated (except in men and children with longstanding severe primary hypothyroidism), but prolactin declines following thyroid hormone replacement therapy. Thyroid hormone is known to affect sex hormone-binding hormonal globulin (SHBG) concentrations. Men with hyperthyroidism have elevated concentrations of testosterone and SHBG. Thyroid hormone therapy in normal men may also duplicate this elevation. In addition estradiol elevations are observed in men with hyperthyroidism, and gynecomastia is common in them as well. In contrast to patients with primary hypothyroidism, men with hyperthyroidism exhibit hyperresponsiveness of LH to GnRH administration and subnormal responses to hCG. Radioactive iodine therapy (RAI) of men treated for thyroid cancer produces a dose-dependent impairment of spermatogenesis and elevation of FSH up to approximately 2 years. Permanent testicular germ cell damage may occur in men treated with high doses of RAI. RAI commonly increases serum concentrations of FSH and LH while reducing inhibin B levels without affecting serum concentrations of testosterone. Thus, radioiodine therapy transiently impairs both germinal and Leydig cell function that usually recover by 18 months posttherapy.
Clinical Practice Guideline
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Georg T hieme Verlag 8. The Hormone Foundation's Patient Guide to the Management of Maternal Hypothyroidism Bef ore, During, and Af ter Pregnancy
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Poppe, K, Glinoer D, Tournaye H et al. Thyroid f unction and assisted reproduction. In: The Thyroid and Reproduction, MET S Riga 2008. Georg T hieme Verlag 8. The Hormone Foundation's Patient Guide to the Management of Maternal Hypothyroidism Bef ore, During, and Af ter Pregnancy. De Groot LJ, Stagnaro-Green A,
Management of Thyroid Dysf unction during Pregnancy and Postpartum: An Endocrine Society 3. Green BB, Weiss NS, Daling JR. Risk of ovulatory inf ertility in relation to body weight
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De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L et al. Management of Thyroid Dysf unction during Pregnancy and Postpartum: An Endocrine Society 3. Green BB, Weiss NS, Daling JR. Risk of ovulatory inf ertility in relation to body weight. Fertility and Sterility