The impact of the thyroid and its disease on female reproductive function
Thyroid disease is more common in women of reproductive age. The paper reviews modern literature on the impact of autoimmune thyroiditis, hypo- and hyperfunction of the thyroid, as well as its structural changes on the female reproductive system. Autoimmune aggression against thyroid cells is frequently associated with reproductive system diseases and is the most common cause of primary hypothyroidism. Hypothyroidism is an easily identifiable risk factor for infertility and pregnancy complications, which responds well to drug therapy. Fetal exposure to the elevated levels of maternal thyroid hormones and thyroid-stimulating hormone (TSH) receptor antibodies can stimulate the fetal thyroid and also lead to the development of a number of diseases at a later period. During pregnancy, the thyroid undergoes structural and functional changes. The management tactics depends on the presence of dysfunction and on the benign/malignant nature of the disease.Smetnik A.A., Sazonova A.I.
Keywords
thyroid
hypothyroidism
hyperthyroidism
autoimmune thyroiditis
reproductive function
infertility
pregnancy
References
- Haugen B.R., Alexander E.K., Bible K.C., Doherty G.M., Mandel S.J., Nikiforov Y.E. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2015; 26(1): 1-133.
- Мельниченко Г.А., Фадеев В.В., Дедов И.И. Заболевания щитовидной железы во время беременности: диагностика, лечение, профилактика. Пособие для врачей. М.: ИнтелТек; 2003. 68с. [Melnichenko G.A., Fadeev V.V., Dedov I.I. Thyroid disease during pregnancy: diagnosis, treatment, prophylaxis (manual for doctors). M.: IntelTek; 2003. 68 p. (in Russian)]
- Фадеев В.В., Перминова С.Г., Назаренко Т.А., Ибрагимова М.X., Топалян С.П. Патология щитовидной железы и беременность. Врач. 2008; 5: 11-6. [Fadeev V.V., Perminova S.G., Nazarenko T.A., Ibragimova M.H. Topalyan S.P. Thyroid pathology and pregnancy. Vrach/ Doctor. 2008; 5: 11-16. (in Russian)]
- Alexander E.K., Pearce E.N., Brent G.A., Brown R.S., Chen H., Dosiou C. et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017; 27(3): 315-89.
- Glinoer D., de Nayer P., Bourdoux P., Lemone M., Robyn C., van Steirteghem A. et al. Regulation of maternal thyroid during pregnancy. J. Clin. Endocrinol. Metab. 1990; 71(2): 276-87.
- Перминова С.Г. Патология щитовидной железы у женщин с бесплодием. Клиническая и экспериментальная тиреоидология. 2011; 7(4): 44-50. [Perminova SG. Thyroid disease in infertile women. Klinicheskaya I experimentalnaya tireoidologia/ Clinical and experimental thyroidology. 2011; 7 (4): 44-50. (in Russian)]
- Poppe K., Glinoer D., Van Steirteghem A., Tournaye H., Devroey P., Schiettecatte J., Velkeniers B. Thyroid dysfunction and autoimmunity in infertile women. Thyroid. 2002; 12(11): 997-1001.
- Quintino-Moro A., Zantut-Wittmann D.E., Tambascia M., Machado H. da C., Fernandes A. High prevalence of infertility among women with graves’ disease and hashimoto’s thyroiditis. Int. J. Endocrinol. 2014; 2014: 982705.
- Kachuei M., Jafari F., Kachuei A., Keshteli A.H. Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch. Gynecol. Obstet. 2012; 285(3): 853-6.
- Monteleone P., Parrini D., Faviana P., Carletti E., Casarosa E., Uccelli A. et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am. J. Reprod. Immunol. 2011; 66(2):108-14.
- Ott J., Aust S., Kurz C., Nouri K., Wirth S., Huber J.C., Mayerhofer K. Elevated antithyroid peroxidase antibodies indicating Hashimoto’s thyroiditis are associated with the treatment response in infertile women with polycystic ovary syndrome. Fertil. Steril. 2010; 94(7): 2895-7.
- Toulis K.A., Goulis D.G., Venetis C.A., Kolibianakis E.M., Negro R., Tarlatzis B.C., Papadimas I. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur. J. Endocrinol. 2010; 162(4): 643-52.
- Chai J., Yeung W.Y., Lee C.Y., Li H.W., Ho P.C., Ng H.Y. Live birth rates following in vitro fertilization in women with thyroid autoimmunity and/or subclinical hypothyroidism. Clin. Endocrinol. (Oxf.). 2014; 80(1): 122-7.
- Tan S., Dieterle S., Pechlavanis S., Janssen O.E., Fuhrer D. Thyroid autoantibodies per se do not impair intracytoplasmic sperm injection outcome in euthyroid healthy women. Eur. J. Endocrinol. 2014; 170(4): 495-500.
- Łukaszuk K., Kunicki M., Kulwikowska P., Liss J., Pastuszek E., Jaszczołt M. et al The impact of the presence of antithyroid antibodies on pregnancy outcome following intracytoplasmatic sperm injection-ICSI and embryo transfer in women with normal thyreotropine levels. J. Endocrinol. Invest. 2015; 38(12): 1335-43.
- Karacan M., Alwaeely F., Cebi Z., Berberoglugil M., Batukan M., Ulug M. et al. Effect of antithyroid antibodies on ICSI outcome in antiphospholipid antibody-negative euthyroid women. Reprod. Biomed. Online. 2013; 27(4): 376-80.
- Zhong Y.P., Ying Y., Wu H.T., Zhou C.Q., Xu Y.W., Wang Q. et al. Relationship between antithyroid antibody and pregnancy outcome following in vitro fertilization and embryo transfer. Int. J. Med. Sci. 2012; 9(2): 121-5.
- Chen L., Hu R. Thyroid autoimmunity and miscarriage: a meta-analysis. Clin. Endocrinol. (Oxf.). 2011; 74(4): 513-9.
- Thangaratinam S., Tan A., Knox E., Kilby M.D., Franklyn J., Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011; 342: d2616.
- van den Boogaard E., Vissenberg R., Land J.A., van Wely M., van der Post J.A., Goddijn M., Bisschop P.H. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum. Reprod. Update. 2011; 17(5): 605-19.
- ESHRE Early Pregnancy Guideline Development Group. Recurrent pregnancy loss. Guideline of the ESHRE; 2017. 154p.
- Negro R. Thyroid autoimmunity and pre-term delivery: brief review and meta-analysis. J. Endocrinol. Invest. 2011; 34(2): 155-8.
- He X., Wang P., Wang Z., He X., Xu D., Wang B. Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur. J. Endocrinol. 2012; 167(4): 455-64.
- Männistö T., Vääräsmäki M., Pouta A., Hartikainen A.L., Ruokonen A., Surcel H.M. et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J. Clin. Endocrinol. Metab. 2009; 94(3): 772-9.
- Abbassi-Ghanavati M., Casey B.M., Spong C.Y., McIntire D.D., Halvorson L.M., Cunningham F.G. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet. Gynecol. 2010; 116(2, Pt 1): 381-6.
- Negro R., Schwartz A., Gismondi R., Tinelli A., Mangieri T., Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J. Clin. Endocrinol. Metab. 2011; 96(6): E920-4.
- Haddow J.E., Cleary-Goldman J., McClain M.R., Palomaki G.E., Neveux L.M., Lambert-Messerlian G. et al.; First- and Second-Trimester Risk of Aneuploidy (FaSTER) Research Consortium. Thyroperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery. Obstet. Gynecol. 2010; 116(1): 58-62.
- Groer M.W., Vaughan J.H. Positive thyroid peroxidase antibody titer is associated with dysphoric moods during pregnancy and postpartum. J. Obstet. Gynecol. Neonatal Nurs. 2013; 42(1): E26-32.
- Krassas G.E., Pontikides N., Kaltsas T., Papadopoulou P., Paunkovic J., Paunkovic N., Duntas L.H. Disturbances of menstruation in hypothyroidism. Clin. Endocrinol. (Oxf.). 1999; 50(5): 655-9.
- Arojoki M., Jokimaa V., Juuti A., Koskinen P., Irjala K., Anttila L. Hypothyroidism among infertile women in Finland. Gynecol. Endocrinol. 2000; 14(2): 127-31.
- Yoshioka W., Amino N., Ide A., Kang S., Kudo T., Nishihara E. et al. Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility. Endocr. J. 2015; 62: 87-92.
- Haddow J.E., Palomaki G.E., Allan W.C., Williams J.R., Knight G.J., Gagnon J. et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N. Engl. J. Med. 1999; 341(8): 549-55.
- Stagnaro-Green A., Abalovich M., Alexander E., Azizi F., Mestman J., Negro R. et al. Guidelines of the American Thyroid Association the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21(10): 1081-125.
- Lazarus J., Brown R.S., Daumerie C., Hubalewska-Dydejczyk A., Negro R., Vaidya B. 2014 European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur. Thyroid J. 2014; 3(2): 76-94.
- Liu H., Shan Z., Li C., Mao J., Xie X., Wang W. et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014; 24(11): 1642-9.
- Chan S., Boelaert K. Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy. Clin. Endocrinol. (Oxf.). 2015; 82(3): 313-26.
- Maraka S., Ospina N.M.S., Mastorakos G., O’Keeffe D.T. Subclinical hypothyroidism in women planning conception and during pregnancy: Who should be treated and how? J. Endocr. Soc. 2018; 2(6): 533-46.
- Bernardi L.A., Cohen R.N., Stephenson M.D. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. Fertil. Steril. 2013; 100(5): 1326-31.
- Shan Z., Teng W., Yu X., Li Y., Fan C., Teng X. et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25–30 months. Clin. Endocrinol. (Oxf.). 2010; 72(6): 825-9.
- Hales C., Taylor P.N., Channon S., Paradice R., McEwan K., Zhang L. et al. Controlled antenatal thyroid screening II: effect of treating maternal suboptimal thyroid function on child cognition. J. Clin. Endocrinol. Metab. 2018; 103(4): 1583-91.
- Krassas G.E., Pontikides N., Kaltsas T., Papadopoulou P., Batrinos M. Menstrual disturbances in thyrotoxicosis. Clin. Endocrinol. (Oxf.). 1994; 40(5): 641-4.
- Song R., Lin H., Chen Y., Zhang X., Feng W. Effects of methimazole and propylthiouracil exposure during pregnancy on the risk of neonatal congenital malformations: A meta-analysis. PLoS One. 2017; 12(7): e0180108.
- Andersen S.L., Olsen J., Laurberg P. Foetal programming by maternal thyroid disease. Clin. Endocrinol. (Oxf.). 2015; 83(6): 751-8.
- Cooper D.S., Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013; 1(3): 238-49.
- Russ G., Bonnema S.J., Erdogan M.F., Durante C., Ngu R., Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU- TIRADS. Eur. Thyroid J. 2017; 6(5): 225-37.
- Kung A.W., Chau M.T., Lao T.T., Tam S.C., Low L.C. The effect of pregnancy on thyroid nodule formation. J. Clin. Endocrinol. Metab. 2002; 87(3): 1010-4.
- Smith L.H., Danielsen B., Allen M.E., Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am. J. Obstet. Gynecol. 2003; 189(4): 1128-35.
Received 13.09.2018
Accepted 21.09.2018
About the Authors
Smetnik, Antonina A., PhD, senior research scientist, Department of Gynecological Endocrinology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Тel.: +74955314444.E-mail: a_smetnik@oparina4.ru
Sazonova, Anna I., PhD, endocrinologist of the Therapeutical Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Тel.: +79099610891. E-mail: anyta_sazonova@mail.ru
For citation: Smetnik A.A., Sazonova A.I. The impact of the thyroid and its disease on female reproductive function. Akusherstvo i Ginekologiya/Obstetrics and Gynecology.2019; (3): 46-52. (in Russian)
https://dx.doi.org/10.18565/aig.2019.3.46-52