Krassas G E, Pontikides N, Kaltsas T, Papadopoulou P, Paunkovic J, Paunkovic N, Duntas L H
Department of Endocrinology, Panagia Hospital, Thessaloniki, Greece.
Clin Endocrinol (Oxf). 1999 May;50(5):655-9. doi: 10.1046/j.1365-2265.1999.00719.x.
Most thyroid textbooks describe hypothyroidism resulting in changes in the length of the menstrual cycle and in the amount of bleeding. Our experience at a busy thyroid clinic had given a picture which differs from that presented in the literature. The aim of this study was to determine the frequency and type of menstrual irregularities in premenopausal hypothyroid patients.
We investigated the menstrual history, starting 6 months before the discovery of the disease, in 171 female premenopausal hypothyroid patients and 214 normal controls, with similar age and body mass index (BMI).
TSH, TT4, TT3 and thyroid antibodies were measured by radioimmunoassay, while BMI was calculated from the ratio of body weight in kg to height in m2.
Of the 171 hypothyroid patients, 131 (76.6%) had regular cycles and 40 (23.4%) irregular periods. Oligomenorrhoea and menorrhagia were the most common features in the latter group. No difference in BMI was found between the patients with or without menstrual abnormalities, or between patients and controls. TSH, TT4 and TT3 levels did not differ between patients with normal and abnormal menstruation. Forty-six (26.9%) out of 171 patients had subclinical hypothyroidism (group A), 42 (24.6%) mild hypothyroidism (group B) and 83 (48.5%) severe hypothyroidism (group C). Thirty-seven from group A (80.4%), 32 from group B (76.2%) and 62 from group C (74.7%) had normal periods. These differences were not statistically significant. Eighty-eight (88.9%) out of 99 patients in whom thyroid antibodies were measured had positive titres. Nineteen (21.6%) of the patients with positive thyroid antibodies had menstrual irregularities. This percentage did not differ from that found in the whole group of patients (23.4%). Out of 214 normal controls, 196 (91.6%) had normal menstruation and 19 (8.4%) irregular cycles. The latter group included mainly women with oligomenorrhoea.
These data demonstrate that hypothyroidism in women is less frequently associated with menstrual disturbance than was previously described. Also, menstrual irregularities tend to be more frequent in sever hypothyroidism in comparison with mild cases, although this finding was not statistically significant. Oligomenorrhoea and menorrhagia are the most common menstrual disturbances.
大多数甲状腺相关教科书都描述了甲状腺功能减退会导致月经周期长度和出血量的改变。我们在一家繁忙的甲状腺诊所的经验所呈现的情况与文献中描述的不同。本研究的目的是确定绝经前甲状腺功能减退患者月经不规律的频率和类型。
我们调查了171名绝经前甲状腺功能减退女性患者和214名年龄及体重指数（BMI）相似的正常对照者在疾病发现前6个月的月经史。
采用放射免疫法测定促甲状腺激素（TSH）、总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）和甲状腺抗体，而BMI通过体重（千克）与身高（米）的平方之比计算得出。
171名甲状腺功能减退患者中，131名（76.6%）月经周期规律，40名（23.4%）月经不规律。月经量少和月经过多是后一组中最常见的特征。月经正常和异常的患者之间、患者与对照者之间的BMI没有差异。月经正常和异常的患者之间TSH、TT4和TT3水平没有差异。171名患者中有46名（26.9%）患有亚临床甲状腺功能减退（A组），42名（24.6%）患有轻度甲状腺功能减退（B组），83名（48.5%）患有重度甲状腺功能减退（C组）。A组中有37名（80.4%）、B组中有32名（76.2%）、C组中有62名（74.7%）月经周期正常。这些差异无统计学意义。99名检测了甲状腺抗体的患者中有88名（88.9%）抗体滴度呈阳性。19名（21.6%）甲状腺抗体阳性患者月经不规律。这个百分比与整个患者组（23.4%）中发现的百分比没有差异。在214名正常对照者中，196名（91.6%）月经正常，19名（8.4%）月经周期不规律。后一组主要包括月经量少的女性。
这些数据表明，女性甲状腺功能减退与月经紊乱的关联比之前描述的要少。此外，与轻度病例相比，重度甲状腺功能减退时月经不规律往往更常见，尽管这一发现无统计学意义。月经量少和月经过多是最常见的月经紊乱情况。
