2. ROLE OF THYROID GLAND
IN REPRODUCTIVE
PHYSIOLOGY
Guide By
Dr.Gayathri Bhat NV Dr.Pooja Lekshmy P
HOD ,Dept. Of PTSR 1st Year PG Scholar
Dept Of PTSR
4. INTRODUCTION
Endocrine system - second key regulator of organ
systems
Thyroid gland – one of the largest endocrine gland
metabolism
growth
development.
Well functioning TG - pivotal for a healthy body & to
conceive a healthy child.
4
6. Thyroid means “oblong
sheild.”
Brownish-red, butterfly
shaped structure - front of
the neck .
justinferior to larynx
from C5 to T1
6
7. Weight 25 gm./1 ounce
Each lobe - 5 x 3 x 2cm
Isthmus – 1.25cm x 1.25 cm x 1.25 cm.
Slightly heavier in females enlarging during
menstruation and pregnancy.
Highly vascular receiving 80-120ml of
bloodmin.
7
8. Microscopic anatomy
includes thyroid follicles -spherical.
0.02 to 0.9mm in diameter.
with a central colloid core surrounded by a
simple epithelium and basal lamina.
Colloid -thyroglobulin.
Parafollicular cells /“C”cells.
8
9. THYROID HORMONES
Thyroid gland – large storage capacity , store
thyroid hormone for 2 to 3 months.
Thyroid hormone include
1. 93% Thyroxine (t4) - 10-25pmol/ltr (normal)
2. 7 % Triiodothyronine(t3) - 1.1-2.3nmol/ltr
3. Thyrocalcitonin – parafollicular cells
Normal value - TSH - 0.45 -5.5mmol/ltr
T3 is about 4 times as potent as T4.
9
14. Action of thyroid
hormones
•Cells Metabolic activity
•CVS Cardiac output
•RS Respiratory rate
•GIT GI motility
•CNS Excitability of nerves
•CARBOHYDRATE METABOLISM
14
•FAT METABOLISM
15. EFFECT ON REPRODUCTIVE
SYSTEM
Females Males
T3 induced modulation TH receptors in Sertoli cells
Estrogen metabolism Male reproductive tract
Sexual maturation development
Menstrual function Maturation of testes (in
Ovulation & Fertility pre-natal and post-natal)
Develop full term infants Maturation of sperm
Stimulates production of
SHBG
(based on research work by National Institute of Environmental
15
Health Science by US Govt)
18. T
H
Y
1ST DEPENDS ON MOTHER
F
TRIMISTER
R
O
O
I 8-10 Pituitary thyroid system
D WEEKS dev E
P
12-14
T
H Iodine Con.,TSH Secr.
Y WEEKS U
S
I
O
20-28
TSH S
WEEKS
L
O
G
Till
Y
18
term
T4 T3 remains Low
24. Anti TSH-r H
Y
Present P
E
TSH R
T
T3&T4 H
Y
R
O
Triad of I
Symptoms D
I
S
M
HYPERTHYROIDIS
24 M
25. CLASSICAL SYMPTOMS
Hoarseness or Persistent
Deepening of Voice Sore or Dry Throat
Nervousness
Swelling Irritability
(Goiter) Difficulty
Sleeping
Difficulty
Swallowing
Rapid or Irregular
Frequent Heartbeat
Bowel
Movements
(diarrhoea)
First-Trimester
Increased Miscarriage
Sweating
Unexplained Excessive Vomiting in
Warm, Moist Palms Weight Loss Pregnancy
Fine tremors
25
26. Effect of Hyperthyroidism in Reproductive system
FEMALES MALES
Increased mean Increased estrogen
plasma estrogen level.&LH
production.
level .
Increased level of SHBG. Defective
Increased incidence of spermatogenesis.
oligomenorrhea Low sperm count with
amenorrhea & anovulation. sperm motility defect.
.
26
27. May cause early onset of menopause
Symptoms – lack of
menstruation, hot flushes,
insomnia, mood swings –
mistaken for menopausal
symptoms.
Treatment of hyperthyroidism –
alleviate symptoms of ,or the
actual onset of early
menopause.
27
28. COMPLICATIONS IN PREGNANCY
Mild maternal tachycardia
heart murmur with irregular heart-beat.
Unexplained weight loss or failure to have normal
pregnancy weight gain.
Spontaneous abortion.
Pregnancy-induced hypertension.
Pre term delivery.
Anaemia.
Higher susceptibility to infections.
Placental abruption.
28
Post partum thyroid dysfunction.
29. Transient hyperthyroidism in pregnancy
Thyroid activity increase in
conditions of
Molar pregnancy.
When hyperemesis gravidorum is
associated with high level of hCG
29
30. EFFECT ON FOETUS
Intra uterine growth retardation.(IUGR)
Low birth weight.
Intrauterine foetal death.
Still birth.
Prematurity.
Skeletal developmental abnormalities.
Foetal-neonatal hyperthyroidism.(plancental transfer
of anti TSH- R).
Overtreatment with antithyroid drugs-foetal
30
goiter.
31. TREATMENT OF
HYPERTHYROIDISM
Antithyroid drugs:
Methimazole : 10 -20 mg daily, once it is
controlled -5 -10 mg daily.
Propanol : 20-40 mg every 12 hr orally.
Surgical removal .
.
31
35. EFFECT ON REPRODUCTIVE
SYSTEM
Delay in onset of puberty with
anovulatory cycle.
Increased prolactin Level; GnRH
reduced
Diminished libido .
Recurrent miscarriage
Amenorrhea, oligomenorrhea,
galactorrhea – due to high prolactin
level
Incidence of infertility and PCOD
Testicular atrophy in men
35
36. Effects on pregnancy
High risk of pre-eclampsia ,often lead to premature
delivery .
Muscle cramps,constipation
Still birth ,low birth weight.
Placental abruption & PPH.
Associated with hypertension,type 1
diabetes,anaemia.
Increased risk of spontaneous abortion.
36
37. EFFECT ON FOETUS
Congenital abnormalities.
Delay in sexual maturity.
Lower IQ in infants of every mild hypothyroid
women.
CHILDREN: CRETINISM:
Congenital Hypothyroidism
Dwarfism
Mentally Subnormal: MR
Enlarged, Protruding tongue
37
Pot bellies.
38. TREATMENT OF HYPOTHYROIDISM.
ELTROXINE
L- THYROXINE – to be given.
Brand name - Eltroxin
During pregnancy regular check up btw
every 4 week .
38
39. INVESTIGATIONS
THYROID FUNCTION TEST
Level of TSH, T3,T4 in blood sample.
Thyroid scan
FNAC
MISCELLANEOUS TEST
include serum cholesterol ,serum creatine
etc
39
40. INCIDENCE RATE.
42 million people in India – TD
Hypothyroidism –
congenital 1 out of 2640 children in India
1 out of 3800 children in World
Adult- 3.9%
Hyperthyroid
Adult -1.6%
40
48. PREVENTION - organ damage
unpleasant symptoms
negative consequences
Beeja Srotho Viprakrushta
dushti vaigunya Hetu
AVOID THE HETU
Early detection
and proper
48
treatment
49. CRITICAL ANALYSIS
Vataja galaganda as per symptoms –Hyper
thyroidism
Kaphaja galaganda as per symptoms –
Hypothyroidism
In other sense hyperTh as Apatarpanotha
vyadhi/ and hypoth as santharpanotha vyadhi
Hence management can be adopted according
to the condition
49
50. CASE REPORT
Name X Symptoms Since
Age 19years
Presenting C/O Weight gain(7kg), 3 months
menorrhagia
History of thyroid nodules Birth
presenting
illness y
PCOD 3 years
Increased TSH 7 Years
Family History Mother - Hypothyroid
Treatment Tab Eltroxin 7 years
50
Investigation TSH level 12mmol/ltr
51. Diagnosis – Hypothyroid(Kaphaja Galagandam)
Treatments given
Kanchanara guggulu 2 Bd for 5 days
Varanadi kwatham 15ml Bd for 5 days
Panchakarma Treatment
Snehapanam with Satavaryadi
Ghritam(30,60,90,110ml)
Vamanam
Satavaryadi avaleha 1tsp Bd
51
TSH after treatment 2.2mmol/ltr
52. Conclusion
TD – Most
Undiagnosed,
overlooked,
overhidden disease.
Present medicinal
therapy – Inadequate
Further research – to
early diagnose and
52
treatment