Menorrhagia as main presentation sign of severe hypothyroidism in a pediatric patient: a case report

Women aged 41–54 had higher FSH in the late luteal phase and early follicular phase, and lower Pd3G and E13G at various timeframes across the cycle compared with younger women (Table S4). Current smokers showed similar patterns compared with never and former smokers even after controlling for age. No consistent patterns between participant characteristics and thyroid hormones were observed (Table S5). Participants for the menstrual cycle function study were recruited between 2004–2006 and 2013–2014. To be eligible, women had to be premenopausal, not pregnant or synthroid news lactating, not currently taking hormonal medications, and never diagnosed with or treated for cancer. This study was approved by the Institutional Review Boards at Emory University and the State Health Department of Michigan.

Experts suspect the link between hypothyroidism and AUB is related to an overlap in the complex feedback loops that regulate these hormones, amongst other potential causes. All the available evidence supports a causative association between hypothyroidism and excessive menstrual loss. Some of the study methods are weak by modern standards, but in the absence of evidence to the contrary the conclusion must be that hypothyroidism is a correctable cause of menorrhagia. Prentice asserts that routine thyroid function tests are of no value in the investigation of women with menorrhagia. Maybe we are just conducting the wrong test of thyroid function, however, and all women with unexplained menorrhagia should be tested for thyrotrophin releasing hormone. This is a descriptive cross-sectional study that was carried out in the department of obstetrics and gynecology at KIST Medical College, Imadol, Lalitpur from 2nd August 2019 to 2nd February 2020.

• Recently, PCOS has been recognized as the most common problem in endocrine practice (35).
• Blood levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were measured, and thyroid Doppler ultrasonography was performed on all patients.
• Onset of thyroid disorders increases with age, and it is estimated that 26 % of premenopausal and menopausal women are diagnosed with thyroid disease 4.
• The most common menstrual abnormalities among women with diabetes are secondary amenorrhea and oligomenorrhea (60).
• The objective examination revealed xerotic and desquamating skin, thinning hair and acanthosis nigricans on neck, armpits and ankles.

Figure 1. Patterns of abnormal uterine bleeding of patients.

Most women in this study with AUB and thyroid dysfunction were found to have overt hypothyroidism. A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College.

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An association between thyroid dysfunction and menstrual disorders has been known for a long time; however, most studies included few patients and did not include a control group. Furthermore, the evaluation of patients in the subcategories of hypo- and hyperthyroidism was performed in a few studies. A recent review investigated menstrual disorders observed in various endocrine diseases. In this review, irregular menstruation, heavy bleeding, oligomenorrhea, and amenorrhea were seen in hypothyroid women, while oligomenorrhea and amenorrhea were seen in hyperthyroid women5. Between 2004–2014, 86 euthyroid premenopausal women not lactating or taking hormonal medications participated in a study measuring menstrual function.

The menstrual cycle length and amount of bleeding can be indicative of endocrine disorders. Further studies are needed to identify the unknowns about the association between endocrine disorders and the menstrual cycle. The thyroid hormones thyroxine (T4) and triiodothyronine (T3) are essential for maintaining your overall health. One of the critical roles of these thyroid hormones is to regulate your metabolism by ensuring every cell receives the energy needed to function correctly. Among hypothyroid patients, the most common complaint was menorrhagia 5 (45.45%), followed by oligomenorrhoea 4 (36.36%), menometrorrhagia 1 (9.1%), and polymenorrhoea 1 (9.1%). The aim of the study is to find the prevalence of thyroid abnormality in abnormal uterine bleeding patients from puberty to those who have not attended menopause.

Clotting factors

• The limitations of our study include the absence of evaluations of parameters affecting menstrual patterns, such as body mass index, and the duration of thyroid dysfunction, in both the patient and control groups.
• A “regular” menstrual cycle ranges from 21 to 35 days, with menstrual bleeding lasting 4 to 7 days.
• To study the prevalence of thyroid dysfunction and thyroid autoimmunity in patients with menstrual disorders and to study their correlation.
• Data available on the subject of women’s reproductive health show menstrual disorders to be a fundamental problem (8, 9).
• The most common type of abnormal uterine bleeding in this study was menorrhagia followed by metrorrhagia.
• Endocrine disorders trigger the onset of menstrual disturbance across the reproductive lifespan of women.

The frequency of menorrhagia was significantly higher in patients with hypothyroidism. If the relationships between thyroid hormones and menstrual cycle function are causal, these findings may be relevant to exogenous factors that influence thyroid function. For example, to the extent that environmental toxicants and personal behaviors such as smoking may affect thyroid function,28, 29 menstrual cycle outcomes and female reproduction may also in turn be affected through this pathway. However, in this study, personal exposures such as smoking were not strongly related to thyroid hormone concentrations. Women in this study were exposed to a persistent organic pollutant (PBB) and most (89%) had detectable levels of PBBs in their blood. However, when controlling for PBB in models or restricting analyses to women with PBB levels below the median, results did not change (data not shown).

Menstrual cycle function protocol

Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid, and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding was menorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between years with the mean age of 31 years.

• Thyroid disorders are more common in women than in men and in older adults compared with younger age groups 5.
• They can order a blood test to measure your thyroid hormone levels and can help you to take the appropriate actions in terms of treatment and medication.
• The substitutive therapy with levothyroxine led to the resolution of heavy bleeding after five days and following normalization of coagulative parameters and pituitary hyperplasia.
• If you’re looking to monitor your thyroid hormone levels, Everlywell offers an easy-to-use, at-home Thyroid Test that can provide all the information you need.
• In the patients with menstrual dysfunction, if thyroid disorders are timely diagnosed and treated, the menstrual irregularities settle, and unnecessary intervention like hormonal treatment and surgery can be avoided.
• Statistical analysis was done using Statistical Package for the Social Sciences version 23.

If you’re experiencing unusual changes in your menstrual cycle, you’re not alone. An estimated 14% to 25% of women report irregular menstrual cycles, also called abnormal uterine bleeding. The strengths of our study include the inclusion of a control group, the examination of subclinical patient groups, and the questioning of patients’ menstrual patterns by a single individual. The limitations of our study include the absence of evaluations of parameters affecting menstrual patterns, such as body mass index, and the duration of thyroid dysfunction, in both the patient and control groups.

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The endocrine system plays a key role in the rhythmicity of the menstrual cycle setting (1, 2). Menstrual disorders are one of the most common gynecological complaints of women (3), a common problem that continues from menarche to menopause (4). As known, the menstrual cycle includes the ovarian and the endometrial cycles (5) in which the cyclic response to the hormone production from the hypothalamus, pituitary, and ovaries (HPO) axis leads to the occurrence of menstrual cycle (6).

Free triiodothyronine (fT3) is a primary determinant of normal post-natal somatic growth and skeletal development, and an important regulator of bone and mineral metabolism in the adult 21. Before puberty, thyroid hormone may be the major prerequisite for normal maturation of bone with untreated childhood hypothyroidism resulting in profound growth retardation and delayed skeletal maturation 22. This failure of growth is probably caused by a decrease of the direct effects of thyroid hormones on skeletal growth and by a secondary reduction in GH secretion and concentration of insulin-like growth factor-1 (IGF-1) 23. Non-classical congenital adrenal hyperplasia (NCCAH) is another disorder that may influence the menstrual cycle; the most common manifestations of menstrual disorder in these patients are primary or secondary amenorrhea and oligomenorrhea (94). Currently, although the same studies focus on a menstrual abnormality in different endocrine disorders, there is no comprehensive study that has searched and summarized these studies.