Krassas G E, Pontikides N, Kaltsas T, Papadopoulou P, Batrinos M
Endocrine Clinic, Panagia Hospital, Thessaloniki, Greece.
Clin Endocrinol (Oxf). 1994 May;40(5):641-4. doi: 10.1111/j.1365-2265.1994.tb03016.x.
In thyroid textbooks it is stated that hyperthyroidism in women may be associated in almost 50% of the cases with hypomenorrhoea, oligomenorrhoea or amenorrhoea and perhaps with reduced fertility. Our experience at a busy thyroid clinic has given a picture which differs from that described in the literature. Most of our female thyrotoxic patients had normal menstruation. This study was performed to define the menstrual abnormalities in hyperthyroidism.
We investigated the menstrual history, starting 6 months before the discovery of the disease, the smoking habits and the body mass index (BMI), in 214 female, premenopausal thyrotoxic patients and a similar number of normal controls matched for age and weight.
TT4 and TT3 were measured by radioimmunoassay, while BMI was calculated from the ratio of body weight in kg to height in m2.
Of the 214 patients, 168 (78.5%) had regular menstrual cycles and 46 (21.5%) irregular cycles. No difference in BMI was found between the patients with or without menstrual abnormalities. Out of the 46 patients with irregular periods, 23 (50%) were smokers, while only 32 out of the 168 patients (19%) with normal periods were smokers (P < 0.001). TT4 levels were higher as a group in patients with menstrual disturbances (mean +/- SD 267.7 +/- 66.9 nmol/l) than in those with normal periods (240.6 +/- 47.6 nmol/l) (P < 0.05). The 23 smokers with irregular periods had higher TT4 levels (280.5 +/- 51.8 nmol/l) than the remaining non-smokers from the same group (241.9 +/- 43.7 nmol/l) (P < 0.01). No such differences were found for TT3 levels. Out of 214 normal controls, matched for age and weight, 196 (91.6%) had normal menstruation and 18 (8.4%) irregular cycles. The latter group included mainly women with oligomenorrhoea. Out of 18 normal controls with irregular periods, 6 (33.3%) were smokers, while 57 (29.1%) out of 196 with normal periods were smokers.
These data demonstrate that hyperthyroidism in women is less frequently associated with menstrual abnormalities than was previously believed. Furthermore, no patient presented with amenorrhoea. Smoking and TT4 levels are strongly associated with the occurrence of menstrual disturbances in thyrotoxicosis.
甲状腺相关教材指出，女性甲状腺功能亢进症患者中，近50%的病例可能伴有月经过少、月经稀发或闭经，或许还伴有生育能力下降。我们在繁忙的甲状腺门诊的经验呈现出与文献描述不同的情况。我们的大多数女性甲状腺毒症患者月经正常。本研究旨在明确甲状腺功能亢进症患者的月经异常情况。
我们调查了214名绝经前甲状腺毒症女性患者以及数量相近、年龄和体重匹配的正常对照者在疾病发现前6个月的月经史、吸烟习惯和体重指数（BMI）。
采用放射免疫分析法测定总甲状腺素（TT4）和总三碘甲状腺原氨酸（TT3），BMI通过体重（千克）与身高（米）平方的比值计算得出。
214例患者中，168例（78.5%）月经周期规律，46例（21.5%）月经周期不规律。月经异常患者与月经正常患者的BMI无差异。在46例月经不规律的患者中，23例（50%）吸烟，而168例月经正常的患者中仅有32例（19%）吸烟（P<0.001）。月经紊乱患者组的TT4水平（均值±标准差267.7±66.9nmol/L）高于月经正常患者组（240.6±47.6nmol/L）（P<0.05）。23例月经不规律的吸烟者的TT4水平（280.5±51.8nmol/L）高于同组其余非吸烟者（241.9±43.7nmol/L）（P<0.01）。TT3水平未发现此类差异。在214名年龄和体重匹配的正常对照者中，196例（91.6%）月经正常，18例（8.4%）月经周期不规律。后一组主要包括月经稀发的女性。在18例月经不规律的正常对照者中，6例（33.3%）吸烟，而196例月经正常的对照者中有57例（29.1%）吸烟。
这些数据表明，女性甲状腺功能亢进症与月经异常的关联比之前认为的要少。此外，没有患者出现闭经。吸烟和TT4水平与甲状腺毒症患者月经紊乱的发生密切相关。
