Different Manifestations of Thyroid Problems in Women

 

Different manifestations of thyroid problem in ladies

Ladies are you bleeding excessively?

Here I narrate 3 different types of cases

A 20 years old girl got admission in medical college.She started living in a hostel. It was a stress situation for her. It was for the first time she was coming out of the four walls of her house. The place she started living was at high altitude . New place, new people, new environment, stress of adjusting with others, and studying all demanded a lot on her stress hormones .
She started having irregular periods,more frequent periods and it bothered her a lot.She became anaemic.Gynaecologists saw her and gave her various hormone combinations[oestogen and progesterone] with no positive result.Sometimes even when she was taking these tablets regularly she will bleed , but her parents and doctors would think that she would have missed tablets.Prior to this her periods didn’t give her any problem.Her first period was at the age of 13 years. It used to come regularly everymonth with no pain , and had normal flow.
As days went she noticed a nodule developing in her thyroid gland. By that time she was already a 3rd year medical student.She reported this to her surgery professor who gave her eltroxin to take.And told her to come back for surgery if still it persisted. But to her surprise she found her periods behaving normally for years together..Later whenever it sidetracked she used to monitor her thyroid levels and get treatment


2 Another lady 35 years old came to me telling “Madam, I am having early periods and heavy also since 3 years.I have delivered normally a child who is 8 years old now.I underwent D&C and pathlology report came as proliferative endometrium I was given progesterone treatment yet I was not responding .So they have posted me for hysterectomy” Since I was in charge of the department at that time I planned her for thyroxine trial She had hypothyroid features of thin hair ,dull facies and frequent periods. But her TSH was 2.4She couldn’t afford other tests. So I started her empirically on Thyroxine sodium 25micrigram. I found her having regular monthly periods with normal flow. I found her later 2 years after coming to my house crying .
She was asked by medical fraternity to stop the tablets since TSH was 2 i.units and her periods problem restarted again She was planned once more for uterus removal .Just a few days before surgery her only son died due to accident. So she came to my house with great hope. I prayed God to help her. I assured her telling “my diagnosis for you is Hypothyroidism and once you have proved I am correct. So again I will start you on Thyroxine and after one period you can take clomiphene “ She did accoprdingly and very next cycle She was pregnant. She was cared and delivered by the same doctors who planned to remove her uterus.. This reminds me of our professors saying” obstetrics is the one field where child comes out exposing your follies right on your face”


There were 4 cases of endocervicitis ,hip pain, congestive dysmenorrhoea, premenstrual spotting, One patient underwent hysteroscopy and D&C.Small polyps were removed and pathology report came as proliferative endometrium
Even after polyp removal premenstrual spotting continued She was given a short course of thyroxine sodium her spotting stopped and without any further problem.
The other 3 had cervical cytology and endometrial sampling They were given a course of antibiotics .On follow up repeat FT3, FT4 , and TSH done showed low thyroxine values in a span of 6 months to 1 year.Thyroxine treatment solved their problem.

Thus hypothyroidism can occur due to

1 T3,T4 deficiency – decreased iodine intake or absorption
decreased hormone production
Increased binding with carrier proteins/antibodies
? decreased receptor availability
2 TSH deficiency [hypopituitorism]

3 Altered TRH response

These patients present to you with
1 normal mense4s but putting on weight,general weakness, succumb to infections frequently
2 amenorrhoea [ no periods]
3 premenstrual bleeding
4 polymenorrhoea [frequent periods]
5 oligomenorrhoea [ scanty periods]
6 menorrhagia,congestive dysmenorrhoeaheavy bleed
7 polymenorrhagia [frequent and heavy ]
8 metrorrhagia [intermenstrual periods]
9.Infertility,rec miscarriages,oron&off bleed during pregnancy

Age group can be 1 pubertal , 2 reproductive, 3 perimenopausal

Investigations

Blood haemogram BT,CT,APTT
Pelvic scan for uterus and ovaries
Cervical cytology and endometrial sampling in 2 and 3 age groups
FT3, FT4, T3,T4,TSH,Thyroperoxidase antibodies

Treatment directed at correcting infections, thyroxine level, hematinics and estrogen/progesterone if needed.