Thyroid disease is common in reproductive age women and has an incidence of 1%. Both hyperthyroidism (increased activity) and hypothyroidism (decreased activity) can be associated with fertility problems. The most common problem encountered with thyroid disease is a ovulatory dysfunction.
Most patients with hypothyroidism will not ovulate, but few women may ovulate irregularly and occasionally conceive spontaneously. Also, recurrent pregnancy loss and other pregnancy problems are commonly seen with hypothyroidism. Subclinical hypothyroidism is explained as an elevated TSH level with normal thyroid hormone concentrations (T4). This phenomenon is associated with reproductive problems as well as metabolic abnormalities.
Hyperthyroidism is defined as a suppressed/low TSH level and elevated thyroid hormones (T3 and/or T4). Hyperthyroidism can also result in ovulatory dysfunction, with other adverse effects if left untreated.Subclinical hyperthyroidism is interpreted as normal thyroid hormone levels and a low TSH level.
According to opinion of the best fertility doctor in Abu Dhabi, Dr Ripal Madnani, It is recommended that thyroid disease screening is required in patients at high risk of having the disease, who have the symptoms, have a significant medical history of autoimmune diseases, history of recurrent pregnancy loss, have ovulatory dysfunction or with the evidence of thyroid gland enlargement on examination.
Hypothyroidism is commonly treated with levothyroxine (Thyroxine) and hyperthyroidism with propylthiouracil (PTU) or methimazole (Tapazole). Treatment should be initiated before pregnancy to improve outcome and minimize pregnancy complications.
Prolactin is the hormone released from the anterior pituitary gland in the brain and has an important role in reproduction and lactation. Normal prolactin level should be less than 35ng/ml.
Hyperprolactinemia, or increased prolactin levels, can cause symptoms like irregular or nonexistent periods, milky breast discharge, infertility, decreased libido, headaches, and visual disturbances. There are several drugs that can increase prolactin levels such as anti-depressants, anti-psychotics, estrogens, anti-androgens, opiates and antihypertensives.
Prolactin levels should be checked again the next morning without any exercise, sexual activity, or other breast stimulation. Once persistently elevated levels are confirmed then physiological and pharmacological causes should be ruled out. Next, MRI of the pituitary gland should be performed to rule out a pituitary tumor. Pituitary tumors size less than 10mm are called microadenomas; those larger than 10mm are named macroadenomas.
Treatment of hyperprolactinemia in most of the cases is medical, through the use of dopamine agonistic drugs such as Bromocriptine and Cabergoline. Both drugs are effective in normalizing prolactin levels, but cabergoline appears to be a better drug with less side effects. Surgery is reserved for patients who do not respond or cannot tolerate medical therapy, with sudden loss of vision or with multiple complications. The success rate with surgical treatment is good in small tumors with a lower recurrence rate.
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