Indian Write-Ups

Introduction

It is only over past few years that dysfunctions of thyroid has been recoginsed as an entity in a wide variety of Gynecological disorders ranging from abnormal sexual development to menstrual disorders, anovulations, infertility and reproductive wastage when pregnancy is achieved.

Subclinical hypothyroidism which is equally pathogenic passes unrecognised. Menorrhagia was the commonest disorder observed by Scott and Mussey (1964). Singh et al (1990) found oligomenorrhoea as the prominent menstrual abnormality. A large number of traditional investigation and bioassay of hormones have been practiced in the diagnosis of menstrual disorders and infertility for a long time, so by doing the thyroid profile (T3, T4, TSH) in all the cases of menstrual disturbances, infertility and in repeated pregnancy losses will help in diagnosis and treatment in time.

Material and Methods

In the present study an attempt was made to evaluate the role of thyroid hormones and TSH in infertility and menstrual disorders in J. L. N. Medical College, Ajmer.

Cases were divided in two groups.

65 cases of infertility in which other test done were, serum prolactin and eudiometrical biopsy as routine with diagnostic laproscopy.

69 cases of menstrual irregularities whose eudiometrical biopsy was done in all cases as routine and ultrasound for pelvic organs.

Discussion

Infertility is defined as the failure of a couple to achieve a pregnancy despite one year regular unprotected sexual intercourse. One of the oldest human problem with widespread prevalence is infertility. Apart from social and economic consequences, infertility has a serious impact on a couple's personal relations and on their physical and mental health. A woman who fails to conceive or carry a pregnancy to term was a source of concern to the society and she herself regarded her plight as a disgrace. Accordingly childlessness is challenging condition to a physician which he has to consider as a disease and to treat it accordingly.

A large number of traditional investigations and biossay of hormones have been practiced in the diagnosis and management of infertility for a long time. By extensive studies it has been proved that for normal sexual function, thyroid secretion of T3, T4 needs to be approximately normal. The actions of thyroid hormones can not be pinpointed to a specific function but probably result from a combination of direct metabolic effects on gonads and excitatory and inhibitory effects operating through anterior pituitary hormones that control sexual functions.

Shalvev et al (1994) studied the routine thyroid functions tests in infertile women and reported the low incidence of hypothyroidism in the pregnant patient is related to the close association between infertility and hypothyroidism. Patient with hypothyroidism can have either primary or secondary amenorrohoea but may be in compensated state with normal thyroxin (T4) levels achieved by increased thyroid stimulating hormone (TSH) secretion.

Menon et al (1995) studied menstrual dysfunction and thyroid disease and reported that there are contradictory reports regarding the types of menstrual disturbances seen in hypothyroidism and hyperthyroidism and a paucity of information in the Indian literature on the subject.

In the present study, in normal women the mean value for T3, T4 and TSH were 1.34 ng/ml, 8.80 g% and 2.06 MIU/L respectively (Table-I). In primary sterile women the values were found to be 1.00 ng / ml, 9.51 g / ml, 3.61 MIC / L respectively (Table-II). Although the values are within the normal range, their is wide variation in the range of blood levels of three hormones. On statistically analysis T3 and TSH level, in these women were found to be statistically significant (Table-III). Our results are in accordance with other reports (Hassler et al, 1958, Singh et al, 1990 and Agarwal et al, 1994).

Table I

T3, T4 and TSH Levels in Normal Women No. of the cases studied 48

Table II

T3, T4 and TSH Levels in Primary Sterile Women No. of the cases studied 65

Table III

Serum T3, T4 and TSH Levels in Normal and Primary Sterile Women