Preview

Obstetrics, Gynecology and Reproduction

Advanced search

Clinical and diagnostic manifestations in women of reproductive age having both hyperthyroidism and hyperandrogenism

https://doi.org/10.17749/2313-7347.2019.13.4.279-288

Abstract

Aim: to study the clinical and diagnostic manifestations of hyperandrogenism (HA) in women with subclinical thyrotoxicosis.

Materials and methods. Sixty three hyperthyroid women with clinical manifestations of HA were examined. Of these, 17 patients (27.0 %) were diagnosed with hyperthyroidism and HA. The control group included 20 practically healthy women of the similar age (20–44 years old) with no signs of HA or other hormonal disorders. All women under observation (patients with thyrotoxicosis and HA syndrome and women from the control group) underwent a thorough clinical examination and were assessed for their hormonal status using biochemical assays. The levels of follicle-stimulating (FSH), luteinizing (LH), thyroid-stimulating (TSH) hormones, prolactin, estradiol (E2), estrone, and total testosterone (Ttotal) were measured as well as the levels of dehydroepiandrosterone- sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP), free triiodothyronine (T3free), free thyroxin (T4free), sex hormone binding globulin (SHBG), androstenedione, and antimullerian hormone.

Results. Patients with hyperthyroidism and HA had significantly (р < 0.05) higher (than normal) levels of FSH, LH, LH/FSH, estrone, 17-OHP, Ttotal, androstenedione, DHEA-S, T3free , and T4free, as well as lower levels (р < 0,05) of TSH (0,390 ± 0,003 mU/ml), E2 (49.86 ± 4.00 pg/ml), and SHBG (49.65 ± 1.20 nmol/L). A course of pathogenetic therapy that included anti-hyperthyroidism treatment (tyrosol 5–10 mg/day for 3 months) followed by anti-HA treatment (combined oral contraceptives) resulted in significant (р < 0,05) reduction in LH, the LH/FSH ratio, estrone, 17-OHP, T3free, T4free, androstenedione (2.64 ± 0.008 ng/ml), DHEA-S (2.15 ± 0.14 pg/ml), Ttotal (1.32 ± 0.10 ng/ml) and in significant (р < 0,05) increase in E2 (69.46 ± 2.58 pg/ml), SHBG (59.59 ± 2.8 nmol/L), and TSH (1,79 ± 0,16 mU/ml).

Conclusion. Combined pathogenetic therapy reduces the clinical manifestations of hyperthyroidism and HA syndrome, and restores the menstrual and reproductive functions of women.

About the Author

N. E. Akhundova
Azerbaijan Medical University
Azerbaijan

Natavan E. Akhundova – PhD, Associate Professor, Department of Obstetrics and Gynecology

100 Bratyev Mardanovykh St., Baku AZ 1078, Azerbaijan.



References

1. Fadeyev V.V. Diagnosis and treatment of Graves disease. [Diagnostika i lechenie bolezni Grejvsa]. Medicinskij sovet. 2014;(4):44–49. (In Russ.).

2. Bahn R.S., Burch H.B., Cooper D.S. et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456–520.

3. Endocrinology: national guidelines. Eds. I.I. Dedova, G.A. Melnichenko. Moskva: GEOTAR-Media, 2012. 1072 p. (In Russ.).

4. Fadeyev V.V. Review of American Thyroid Association guidelines for diagnosis and treatment of hyperthyroidism and other causes of thyrotoxicosis. [Po materialam klinicheskih rekomendacij Amerikanskoj Tireoidnoj Associacii po diagnostike i lecheniyu tireotoksikoza 2016]. Klinicheskaya i eksperimental’naya tireoidologiya. 2017;13(3):45–56. (In Russ.). DOI: 10.14341/ket2017345-56.

5. Titova L.Yu., Aristarhov V.G., Aristarhov R.V., Puzin D.A. Laser therapy in the treatment of infertility and menstrual function against the background of autoimmune thyroiditis. [O vliyanii infrakrasnoj lazernoj terapii na tireoidnyj gormonal’nyj status u zhenshchin pri narushenii menstrual’noj funkcii.] Nauka molodyh – Eruditio Juvenium. 2017;5(2):291–7. (In Russ.). DOI: 10.23888/HMJ20172291-297.

6. Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol. 2013;9(12):724–34. DOI: 10.1038/nrendo.2013.193.

7. Karrer-Voegeli S., Rey F., Reymond M.J. et al. Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism. Medicine (Baltimore). 2009;88(1):32–45. DOI: 10.1097/md.0b013e3181946a2c.

8. Mikhailova S.V., Zykova T.A. Autoimmune thyroid diseases and reproductive disorders in women. [Autoimmunnye bolezni shchitovidnoj zhelezy i reproduktivnye narusheniya u zhenshchin]. Sibirskij medicinskij zhurnal. 2013;(8):26–31. (In Russ.).

9. Gorsheneva E.B., Svirkova A.S. Influence of hormonal imbalance on functional disorders of reproductive system in women in Tambov province. [Vliyanie gormonal’nogo disbalansa na funkcional’nye rasstrojstva reproduktivnoj sistemy u zhenshchin v Tambovskoj oblasti]. Vestnik Tambovskogo universiteta. Seriya: Estestvennye i tekhnicheskie nauki. 2017;22(6):1665–70. (In Russ.). DOI: 10.20310/1810-0198-2017-22-6-1665-1670.

10. Haring R., Hannemann A., John U. et al. Age-specific reference ranges for serum testosterone and androstenedione concentrations in women measured by liquid chromatography-tandem mass spectrometry. Am J Clin Endocrinol Metab. 2012;97(2):408–15. DOI: 10.1210/jc.2011-2134

11. Azziz R. PCOS in 2015: new insights into the genetics of polycystic ovary syndrome. Nat Rev Endocrinol. 2016;12(2):74–5. DOI: 10.1038/nrendo.2015.230.

12. Liashuk P.M., Liashuk R.P. Main syndromes of hyperandrogenia in women: pathogenesis, differential diagnosis (literature review and own observation). [Osnovnye sindromy giperandrogenii u zhenshchin: patogenez, differencial’naya diagnostika (obzor literatury i sobstvennye nablyudeniya)]. Mezhdunarodnyj endokrinologicheskij zhurnal. 2019;15(1):63–6. (In Russ.). DOI: 10.22141/2224-0721.15.1.2019.158697.

13. Molashenko N.V., Troshina E.A., Sazonova A.I., Uzhegova Zh.A. Clinical recommendations. Diagnosis and treatment recommendations for congenital dysfunction of suprarenal cortex in adult patients. [Klinicheskie rekomendacii. Diagnostika i lechebno-profilakticheskie rekomendacii pri vrozhdennoj disfunkcii kory nadpochechnikov u pacientov vo vzroslom vozraste]. Moskva, 2016. 28 s. (In Russ.). Available at: https://www.endocrincentr.ru/sites/default/files/specialists/science/clinic-recomendations/vkdn.pdf.

14. Ghosh S., Chaudhuri S., Jain V.K., Aggarwal K. Profiling and hormonal therapy for acne in women. Indian J Dermatol. 2014;59(2):107–15. DOI: 10.4103/0019-5154.127667.

15. Hari A., Reddy S., Hri A., Bhatia N., Srikanth A. Premature ovarian failure in autoimmune polyglandular syndrome. Am J Med Science. 2013;2(3):770–6. DOI: 10.5455/medscience.2013.02.8077.

16. Yunusov A.A. Thyroid homeostasis and reproductive hormonal disorders in women. [Tireoidnyj gomeostaz i disgormonal’nye narusheniya reproduktivnoj sistemy u zhenshchin]. Mezhdunarodnyj endokrinologicheskij zhurnal. 2014;(8):100–6. (In Russ.).

17. Ferriman D., Gallwey J.D. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21(11):1440–7. DOI: 10.1210/jcem-21-11-1440.

18. Esina M.M. System of reproduction in hypothyreosis. [Sistema reprodukcii pri gipotireoze]. Arhiv akusherstva i ginekologii im. V.F. Snegireva. 2017;4(2):77–83. DOI: 10.18821/2313-8726-2017-4-2-77-83. (In Russ.).

19. Dobrokhotova Yu.E., Dzhobava E.M., Ragimova Z.E., Gerasimovich M. Yu. Combined oral contraceptives in the treatment of clinical manifestations of hyperandrogenism. [Kombinirovannye oral’nye kontraceptivy v lechenii klinicheskih proyavlenij giperandrogenii]. Lechebnoe delo. 2007;(4):53–7. (In Russ.).

20. Khashchenko E.P., Uvarova E.V., Batyrova Z.K. et al. Possibilities of dermatological manifestations of hyperandrogenism treatment and contraception in young girls. [Vozmozhnosti terapii kosmetologicheskih proyavlenij giperandrogenii i kontracepcii u molodyh devushek]. Reproduktivnoe zdorov’e detej i podrostkov. 2017;(6):84–90. (In Russ.).

21. Ndefo U.A., Eaton A., Green M.R. Polycystic ovary syndrome. A review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336–55.

22. Balan V.E., Zaydieva Ya.Z., Tikhomirova E.V. Effective treatment of skin and metabolic manifestations of hyperandrogenism: a comprehensive improvement of quality of life. [Effektivnoe lechenie kozhnyh i metabolicheskih proyavlenij giperandrogenii – kompleksnoe uluchshenie kachestva zhizni]. Medicinskij sovet. 2019;(7):45–50. DOI: 10.21518/2079-701X-2019-7-45-50. (In Russ.).

23. Lortscher D., Admani S., Satur N., Eichenfield L.F. Hormonal contraceptives and acne: a retrospective analysis of 2147 patients. J Drugs Dermatol. 2016;15(6):670–4.

24. Arowojolu A.O., Gallo M.F., Lopez L.M., Grimes D.A. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012;(7):CD004425. DOI: 10.1002/14651858.CD004425.pub6.


Review

For citations:


Akhundova N.E. Clinical and diagnostic manifestations in women of reproductive age having both hyperthyroidism and hyperandrogenism. Obstetrics, Gynecology and Reproduction. 2019;13(4):279-288. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.4.279-288

Views: 738


ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)