A study of association of thyroid disorders in patients with abnormal uterine bleeding

INTRODUCTION: It has been long recognized that thyroid dysfunction may have profound effects on the female reproductive system. A relationship between the thyroid gland and the gonads is suggested by far more frequent occurrence of thyroid disorders in women than in men by clinical appearance of goitre during pregnancy, puberty and menopause. Thyroid disorders are 10 times more common in women than in men). Currently subclinical thyroid dysfunction is on the rising side than overt dysfunction. The effect of thyroid hormones is due to the direct metabolic effects on the gonads as well as indirectly through alterations in anterior pituitary hormones that control the sexual functions. Regular menstruation is a feature of contemporary society. Large family size, prolonged breast feeding and reduced life expectancy limited the number of cycles experienced by women in the past. Currently women may experience more than 400 menstruations between menarche and menopause. One of the common causes of women attending gynecology OPD is abnormal uterine bleeding constituting around 30 percentages. Majority of women who present with bleeding problems, no underlying abnormality could be made out. It is quite often this situation tackled with fractional curettage and finally hysterectomy. AUB encompasses a wide spectrum of disorders such as reproductive tract diseases, systemic diseases and iatrogenic causes. Thyroid dysfunction accounts for 30% - 40% of cases in systemic disorders causing AUB. The goal of evaluation of AUB is to arrive at an accurate and clinically useful diagnosis in the most efficient and cost effective manner possible. Thyroid function test is helpful in women presenting with AUB to detect subclinical conditions and provide an opportunity to treat the cause. This will avoid unnecessary hormonal treatment, surgery and reduce patient morbidity. AIM OF THE STUDY: 1. To determine the association between menstrual irregularities and thyroid dysfunction. 2. To analyze the pattern of menstrual dysfunction among women with thyroid disorder. 3. To estimate the prevalence of subclinical thyroid diseases among women in the reproductive age group with abnormal uterine bleeding. 4. To establish if screening for thyroid abnormalities is justified using T3 , T4, TSH. MATERIALS AND METHODS: Type of Study: Open label, randomised Prospective Trial. Period of study: July 2011 to October 2012. Sample size: 110. Place of study: Department of Obstetrics and Gynaecology, Govt. Kilpauk Medical College Hospital, Chennai. Selection of Study Population: The study comprised of 110 abnormal uterine bleeding cases admitted in the gynaecology ward through OPD. The Study group included women with following complaints. 1. Oligomenorrhoea, 2. Hypomenorrhoea, 3. Menorrhagia, 4. Polymenorrhoea, 5. Amenorrhoea. Inclusion Criteria: 1. Age group 18-45 years. 2. Women with any of the following menstrual disturbancesmenorrhagia, Oligomenorrhoea, Hypomenorrhoea, Polymenorrhoea, Amenorrhoea with no pelvic pathology. 3. Non IUCD user. 4. Not using any hormonal preparations. 5..) With symptoms of thyroid dysfunction. Exclusion Criteria: 1. Presence of palpable pelvic pathology – Fibroids, polyp, cervical growth. 2. History of Bleeding diathesis and clotting abnormalities. 3. Patient on drug like aspirin, heparin, antithyroid agents and thyroxine. 4. Known case of diabetes mellitus and systemic hypertension. METHDOLOGY: The patients selected for the study were counselled for undertaking the thyroid function test. Detailed menstrual history including length of the cycle, duration of the flow and number of pads usage were elicited and history regarding symptoms of hypothyroidism and hyperthyroidism also elicited. General examination including anaemia, height of the patients (cm), weight of the patient (kg), thyroid enlargement were assessed. Body mass index was calculated using height and weight. Systemic examination were carried out. Abdominal examination, speculum and pelvic examination done to rule out other causes of abnormal uterine bleeding. Investigations-complete blood count, platelet count, bleeding time, and clotting time, urine routine, blood sugar, RFT carried out. USG Pelvis done. Histopathological examination of endometrium performed by pipelle’s curette. Thyroid function test-Serum TSH, free T3 and free T4 are compulsory. 5ml of blood was taken in dry glass contains without any anticoagulant. Fasting sample was taken, TSH assay was performed using IRMA Kit (Immuno radio metric assay). RESULTS : Patients with thyroid dysfunction were grouped as thyroid dysfunction cohort and the remaining patients had AUB alone were grouped as normal cohort. The following factors were taken for analysis- age, parity, AUB types, socioeconomic status, episodes of AUB, body mass index, family history of thyroid disorders, uterine size, endometrial histopathology, haemoglobin, bleeding time, clotting time and platelet count. The predictor of thyroid dysfunction was analysed using the factor duration of AUB and regression coefficient curve.Logistic regression model analysis is used to find out the effective predictor of thyroid dysfunction. CONCLUSION: Our study highlights the following facts: The significant association between abnormal uterine bleeding and thyroid disorder (10%). It brings into focus the increased incidence of hypothyroidism among women with menorrhagia. It proves beyond doubt that TSH assay can be used in selective screening of women with abnormal uterine bleeding and in prevalence of subclinical hypothyroidism (21.4%) as per AACE guidelines in this study. We are treating only tip of the disease but the submerging part of the disease also needs surveillance at frequent intervals to treat patients at the earliest and prevent morbidities in later life.