وصف
Thyroid disorders can significantly impact reproductive health. Thyroid dysfunction can affect fertility, causing irregular menstrual cycles and ovulatory problems, making conception more challenging. Underactive thyroid (hypothyroidism) is associated with an increased risk of infertility and may lead to difficulties in getting pregnant. Untreated thyroid disorders during pregnancy can lead to complications, including miscarriage, preterm birth, and developmental issues in the baby. Overactive thyroid (hyperthyroidism) can also disrupt menstrual cycles and increase the risk of infertility. Maintaining a proper balance of thyroid hormones is crucial for reproductive health, as these hormones regulate the menstrual cycle and pregnancy. PCOS and thyroid disorders often coexist, compounding the reproductive challenges women may face.
Timely diagnosis and management of thyroid disorders are essential for minimizing their impact on reproductive health. Thyroid hormone replacement therapy can help restore hormonal balance, promoting fertility and a healthy pregnancy.
ملخص
- Thyroid hormones play a crucial role in regulating metabolism, growth, and development, particularly in the central nervous system. Thyroid disorders, including hypothyroidism and hyperthyroidism, are more prevalent in women and can significantly impact reproductive health. These hormones directly influence the ovaries, endometrium, trophoblast, and placenta, affecting processes like granulosa cell proliferation, progesterone production, embryo implantation, and angiogenesis.
- In males, thyroid hormone receptors in Sertoli and Leydig cells modulate spermatogenesis and androgen receptor activity. During pregnancy, physiological changes such as increased hCG, higher TBG levels, and increased iodine excretion influence thyroid hormone production and requirements. Hypothyroidism, characterized by elevated TSH levels, can be overt or subclinical, with Hashimoto's thyroiditis being a common cause in iodine-sufficient areas.
- Hypothyroidism can lead to infertility, menstrual irregularities, and increased miscarriage rates. Treatment with levothyroxine can improve reproductive outcomes. While the Cochrane database suggests that thyroxine replacement may not significantly improve live birth rates, other studies indicate that thyroid autoantibodies can have a detrimental effect on pregnancy. Pregnancy-specific TSH reference levels are essential for managing hypothyroidism in pregnant women, as deficiency can increase the risk of adverse pregnancy outcomes.
- Hyperthyroidism, often caused by Graves' disease, presents with nervousness, weight loss, and increased heart rate. Diagnosis involves assessing TSH, T3, and T4 levels, and radioactive iodine uptake scans. Management includes antithyroid medications like methimazole and propylthiouracil, with propylthiouracil preferred in the first trimester due to methimazole's teratogenic potential. Beta-blockers can alleviate thyrotoxic symptoms.
- Thyroid nodules detected during pregnancy can be evaluated with fine needle aspiration. Treatment can be postponed until postpartum unless malignancy is suspected, in which case surgery during the second trimester may be necessary. Polish guidelines recommend evaluating thyroid function in women with fertility problems, with levothyroxine treatment for overt and subclinical hypothyroidism.
- For women undergoing fertility treatment, maintaining TSH levels below 2.5 mIU/L is crucial. Levothyroxine may be considered prophylactically for those with TSH between 2.5 and the upper limit of normal. Elevated thyroid peroxidase antibody levels may warrant considering ICSI over IVF. A waiting period of 12 months is advised after radioactive iodine treatment before attempting pregnancy, and close monitoring of thyroid function is necessary for women with elevated anti-TPO antibodies during pregnancy.
نموذج شهادة
حول المتحدثين
Dr. Koyalagundla Nayanisri,
Consultant Gynecologist and Infertility Specialist
تعليقات
تعليقات
يجب عليك تسجيل الدخول لتتمكن من ترك تعليق.