GYN CHRONICLES
Women And Thyrod Disease
Dr . Maureen Owiti
The bi-monthly writing time is here and I have chosen on discussing Women and Thyrod Disease , not a very common topic , but a very interesting one , and hopefully with insights you will find valuable .
Enter Gabriella ( not her real name as usual !) Gabriella was a marketing executive for one of the leading advertising agencies in the country , very stressed and irritable due to the demands of her job - or so she thought . As I deal with fertility in my clinic , she came in because she had been married for two years and was unable to conceive .
As she walked into the room the first thing that struck me was the obvious change in her eyes . She was very thin and her eyes were protruding significantly and her iris was nicely surrounded by the sclera nowehere touching her eyelids , what physicians would refer to as exophthalmos . Hyperthyroid patient I thought silently to myself but let us see . I welcomed her into the office and come one , come all , she had been escorted by her husband - Mark .
I dutifully introduced myself and enquired what had led them to come and see me . Gabriella looked at Mark as if getting permission to proceed and began to narrate how the two of them had been married , two years to be precise and desired to have a child .
In my typical fassion , I asked the gynaecologists most common question …. I hope you can all guess ! Of course , the question is : when did you receive your last period ? Gabriella had to think for a while and finally stated she could not remember as her periods were quite irregular . I asked if her periods were irregular , why had it taken her so long to come for a consultation regarding child bearing . She looked at me in shock as she believed that was her normal pattern and was not aware it may affect her chances .
I asked how long she could stay without menses and she reported 2-3 months on average . History being history we established she had always been very thin and found it difficult to gain weight even if she put in a lot of effort . She also noticed she was very uncomfortable in hot places and even when everyone else appeared comfortable she felt hot and
“
If the thyroid levels are not controlled the baby may be born with hyperthyroidism and if the medication is too high the baby may get hypothyroidism , whose worst form manifests as cretinism . This is a serious disorder in children that presents with mental retardation , dwarfism due to stunted growth and physical deformities . bothered . She also noticed that she got easily irritated or annoyed . From her sexual , medical and social history , nothing else came up other than the irregular cycles . On physical exam she also had another typical sign of thyroid disease - a goitre . This is a swelling on the lower part of the neck but hers was not so pronounced .
Despite the history of irregular periods we had to rule out the possibility of a pregnancy and this was negative on blood test . We also did her thyroid hormones and prolactin levels , sent her for an Ultrasound of the neck and pelvis to rule out any other cause of irregular cycles and surprise , surprise her blood picture was classical hyperthyroid state - low thyroid stimulating hormone ( TSH ) with elevated triiodothyronine ( T3 ) and thyroxine ( T4 ).
Her fallopian tubes were patent and Mark had a great semenalysis and I joked with him , that he would make a great donor . Gabriella was obviously not amused and did not appreciate the joke , but I managed to calm her down . Based on her elevated thyroid I recommended she be put on antithyroid medications but as I am usually very cautious , I also sent her for an endocrinologist review for concomitant management as she would primarily be under the care of physicians in view of the diagnosis .
With the anti-thyroid medication , we managed to control her thyroid and as Gabriella was just 28 years old I told her to be patient and started her on some ovulation induction once thyroid levels were deemed normal . Within 3 months of the ovulation induction , she managed to conceive . Thyroid disease can affect both the baby and the pregnancy itself . It is for this reason that she had to be on antithyroid medication with serial monitoring of the thyroid hormones throughout the gestation period .
22 MAL48 / 22 ISSUE