OTOİMMÜN TİROİDİTİ OLAN HASTALARDA PREMATÜR OVARYAN YETMEZLİK SIKLIĞI
Yıl 2022,
, 317 - 321, 01.12.2022
Ceren Yıldız Eren
,
Hulusi Göktuğ Gürer
,
Özlem Özgür Gürsoy
,
Ozge Godek
Öz
Giriş ve Amaç: Premature ovaryan yetmezlik, bazı durumlarda otoimmünitenin etken olduğu, yumurtalıkların kırk yaşın altında fonksiyonlarını kaybetmesidir. Anti-Müllerian hormon, yumurtalık foliküllerinin granüloza hücreleri tarafından salgılanmaktadır. Yumurtalık rezervi AMH ölçümleri ile doğru bir şekilde değerlendirilebilir. Bu çalışmada otoimmün tiroidit tanısı alan kadınlarda Anti-Müllerian hormon düzeyine göre over rezervinin değerlendirilmesi amaçlanmıştır.
Materyal ve Metot: Bu retrospektif bir çalışmadır, Ocak 2011-Mayıs 2021 arasındaki 10 yıllık dönemi kapsamaktadır. Çalışmanın örneklemini 35 yaş altı otoimmün tiroidit nedeniyle takip ve tedavi edilen kadınlar oluşturmaktadır. Katılımcıların yumurtalık rezervleri yaşa özel AMH seviyeleri kullanılarak analiz edilmiştir. Araştırmanın yürütüldüğü sağlık merkezindeki radyoimmunoassay laboratuvarında tiroid hormon düzeyleri ölçülmüştür.
Bulgular: Bazı katılımcılarda infertilite (%66.6) yoktu. Katılımcıların 147'si (%38,7) ötiroid idi. 197 katılımcının (%51,8) yumurtalık rezervi düşük, 229 katılımcının (%60,3) yüksek anti-TPO ve 217 katılımcının (%57,2) yüksek anti-TG düzeyi vardı. Yumurtalık rezervi düşük olan katılımcılar tiroid hormon analiz sonuçları açısından gruplar arasında istatistiksel olarak anlamlı farklılık göstermektedir (p<0.05).
Sonuç: Hipotiroidili katılımcıların diğer gruplara göre daha düşük ortalama AMH ve yumurtalık rezervine sahip oldukları belirlendi.
Kaynakça
- 1. Nelson LM. (2009) Clinical practice. Primary ovarian insufficiency. N Engl J Med, 360(6):606–14.
- 2. De Vos M, Devroey P, Fauser BCJM (2010). Primary ovarian insufficiency. Lancet (London, England), 376(9744):911–21.
- 3. Nelson SM, Iliodromiti S, Fleming R, Anderson R, McConnachie A, Messow C-M. (2014) Reference range for the antimüllerian hormone Generation II assay: a population study of 10,984 women, with comparison to the established Diagnostics Systems Laboratory nomogram. Fertil Steril, 101(2):523–9.
- 4. Michalakis KG, Mesen TB, Brayboy LM. (2011) Subclinical elevations of thyroid-stimulating hormone and assisted reproductive technology outcomes. Fertil Steril, 95(8):2634–7.
- 5. Weetman AP. (2021) An update on the pathogenesis of Hashimoto’s thyroiditis. J Endocrinol Invest, 44(5):883–90.
- 6. Allam MM, El-Zawawy HT, Barakat SS, Ahmed SM, Saleh RNM. (2020) A hidden cause of infertility in hypothyroid patients. Clinical case reports, 8:374–8.
- 7. Rodríguez-Castelán J, Anaya-Hernández A, Méndez-Tepepa M, Martínez-Gómez M, Castelán F, Cuevas-Romero E (2017) Distribution of thyroid hormone and thyrotropin receptors in reproductive tissues of adult female rabbits. Endocr Res, 42(1):59–70.
- 8. Meng L, Rijntjes E, Swarts HJM, Keijer J, Teerds KJ. (2017) Prolonged hypothyroidism severely reduces ovarian follicular reserve in adult rats. J Ovarian Res, 10(1):1–8.
- 9. Colella M, Cuomo D, Giacco A, Mallardo M, De Felice M, Ambrosino C. (2020) Thyroid Hormones and Functional Ovarian Reserve: Systemic vs. Peripheral Dysfunctions. J Clin Med, 9(6):31–6.
- 10. Goswami R, Marwaha RK, Goswami D. (2006) Prevalence of thyroid autoimmunity in sporadic idiopathic hypoparathyroidism in comparison to type 1 diabetes and premature ovarian failure. J Clin Endocrinol Metab, 91(11):4256–9.
- 11. La Marca A, Sighinolfi G, Radi D. (2010) Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update, 16(2):113–30.
- 12. Bahri S, Tehrani FR, Amouzgar A. (2019) Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord, 19(1):47.
- 13. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. (2015) Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod, 30(7):1690–6.
- 14. Coulter B (2017). Anti-Müllerian hormone, Access Use, Instructions For Useitle. 11/04/2020 https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/b15676/a/Access AMH_B15676-A_English.pdf
- 15. BRAHMS (2021). Thyroid Markers for Diseases in Endocrinology. 11/04/2020 https://www.brahms.de/en-gb/products/endocrinology.html
- 16. Alexander EK, Pearce EN, Brent GA. (2017) Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, 27(3):315–89.
- 17. Morales-Martínez FA, Sordia-Hernández LH, Ruiz MM, Garcia-Luna S, Valdés-Martínez OH, Vidal-Gutierez O. (2021) Association between thyroid autoimmunity and ovarian reserve in women with hypothyroidism. Thyroid Res, 14(1):6.
- 18. Krassas GE, Poppe K, Glinoer D. (2021) Thyroid function and human reproductive health. Endocr Rev, 31(5):702–55.
- 19. Gawlik A, Malecka-Tendera E. (2014) Transition In Endocrinology: Treatment of Turner’s syndrome during transition. Eur J Endocrinol, 170(2):R57–74.
- 20. Grossi A, Crinò A, Luciano R, Lombardo A, Cappa M, Fierabracci A. (2013) Endocrine autoimmunity in Turner syndrome. Ital J Pediatr, 39:79.
- 21. Fukuda I, Hizuka N, Kurimoto M. (2009) Autoimmune thyroid diseases in 65 Japanese women with Turner syndrome. Endocr J, 56(8):983–6.
- 22. Monteleone P, Parrini D, Faviana P (2011) Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol, 66(2):108–14.
- 23. Saglam F, Onal ED, Ersoy R. (2015) Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease. Gynecol Endocrinol, 31(2):165–8.
- 24. Chen C-W, Huang Y-L, Tzeng C-R, Huang R-L, Chen C-H. (2017) Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid, 27(9):1194–200.
- 25. Ke H, Hu J, Zhao L, Ding L, Jiao X, Qin Y. (2020) Impact of thyroid autoimmunity on ovarian reserve, pregnancy outcomes, and offspring health in euthyroid women following in vitro fertilization/intracytoplasmic sperm injection. Thyroid, 30(4):588–97.
- 26. Osuka S, Iwase A, Goto M (2018). Thyroid autoantibodies do not impair the ovarian reserve in euthyroid infertile women: a cross-sectional study. Horm Metab Res, 50(07):537–42.
- 27. Kuroda M, Kuroda K (2018) Levothyroxine supplementation improves serum anti‐Müllerian hormone levels in infertile patients with Hashimoto’s thyroiditis. J Obstet Gynaecol Res, 44(4):739–46.
- 28. Fanchin R, Taieb J, Lozano DHM, Ducot B, Frydman R, Bouyer J. (2005) High reproducibility of serum anti-Müllerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status. Hum Reprod, 20(4):923–7.
- 29. Moslehi N, Shab-Bidar S, Tehrani FR, Mirmiran P, Azizi F. (2018) Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause, 25(9):1046–55.
- 30. Hollowell JG, Staehling NW, Flanders WD (2002). Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab, 87(2):489–99.
PREVALENCE OF PREMATURE OVARIAN FAILURE IN PATIENTS WITH AUTOIMMUNE THYROIDITIS
Yıl 2022,
, 317 - 321, 01.12.2022
Ceren Yıldız Eren
,
Hulusi Göktuğ Gürer
,
Özlem Özgür Gürsoy
,
Ozge Godek
Öz
Introduction and Aim: Premature ovarian failure is the loss of function of the ovaries under the age of forty that autoimmunity is a factor in some cases. Anti-Müllerian hormone is secreted by the granulosa cells of the ovarian follicles. Ovarian reserve can be accurately assessed with AMH measurements. This study aimed to evaluate the ovarian reserve by Anti-Müllerian hormone level in women who were diagnosed with autoimmune thyroiditis.
Methods: This is a retrospective study, covers the 10-year period between January 2011 and May 2021. Women under the age of 35 who were followed up and treated for autoimmune thyroiditis constitute the sample of the study. Participants' ovarian reserves were analyzed using age specific AMH levels. Thyroid hormone levels were measured in the radioimmunoassay laboratory in the health center where the study was conducted.
Results: Some participants did not have infertility (66.6%). 147 (38.7%) of the participants were euthyroid. 197 participants (51.8%) had a low ovarian reserve, 229 (60.3%) of the participants had high anti-TPO and 217 (57.2%) had high anti-TG levels. Participants with low ovarian reserve show a statistically significant difference between the groups in terms of thyroid hormone analysis results (p<0.05).
Conclusions: It was determined that the participants with hypothyroidism had a lower mean AMH and ovarian reserve compared to the other groups.
Kaynakça
- 1. Nelson LM. (2009) Clinical practice. Primary ovarian insufficiency. N Engl J Med, 360(6):606–14.
- 2. De Vos M, Devroey P, Fauser BCJM (2010). Primary ovarian insufficiency. Lancet (London, England), 376(9744):911–21.
- 3. Nelson SM, Iliodromiti S, Fleming R, Anderson R, McConnachie A, Messow C-M. (2014) Reference range for the antimüllerian hormone Generation II assay: a population study of 10,984 women, with comparison to the established Diagnostics Systems Laboratory nomogram. Fertil Steril, 101(2):523–9.
- 4. Michalakis KG, Mesen TB, Brayboy LM. (2011) Subclinical elevations of thyroid-stimulating hormone and assisted reproductive technology outcomes. Fertil Steril, 95(8):2634–7.
- 5. Weetman AP. (2021) An update on the pathogenesis of Hashimoto’s thyroiditis. J Endocrinol Invest, 44(5):883–90.
- 6. Allam MM, El-Zawawy HT, Barakat SS, Ahmed SM, Saleh RNM. (2020) A hidden cause of infertility in hypothyroid patients. Clinical case reports, 8:374–8.
- 7. Rodríguez-Castelán J, Anaya-Hernández A, Méndez-Tepepa M, Martínez-Gómez M, Castelán F, Cuevas-Romero E (2017) Distribution of thyroid hormone and thyrotropin receptors in reproductive tissues of adult female rabbits. Endocr Res, 42(1):59–70.
- 8. Meng L, Rijntjes E, Swarts HJM, Keijer J, Teerds KJ. (2017) Prolonged hypothyroidism severely reduces ovarian follicular reserve in adult rats. J Ovarian Res, 10(1):1–8.
- 9. Colella M, Cuomo D, Giacco A, Mallardo M, De Felice M, Ambrosino C. (2020) Thyroid Hormones and Functional Ovarian Reserve: Systemic vs. Peripheral Dysfunctions. J Clin Med, 9(6):31–6.
- 10. Goswami R, Marwaha RK, Goswami D. (2006) Prevalence of thyroid autoimmunity in sporadic idiopathic hypoparathyroidism in comparison to type 1 diabetes and premature ovarian failure. J Clin Endocrinol Metab, 91(11):4256–9.
- 11. La Marca A, Sighinolfi G, Radi D. (2010) Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update, 16(2):113–30.
- 12. Bahri S, Tehrani FR, Amouzgar A. (2019) Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord, 19(1):47.
- 13. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. (2015) Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod, 30(7):1690–6.
- 14. Coulter B (2017). Anti-Müllerian hormone, Access Use, Instructions For Useitle. 11/04/2020 https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/b15676/a/Access AMH_B15676-A_English.pdf
- 15. BRAHMS (2021). Thyroid Markers for Diseases in Endocrinology. 11/04/2020 https://www.brahms.de/en-gb/products/endocrinology.html
- 16. Alexander EK, Pearce EN, Brent GA. (2017) Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, 27(3):315–89.
- 17. Morales-Martínez FA, Sordia-Hernández LH, Ruiz MM, Garcia-Luna S, Valdés-Martínez OH, Vidal-Gutierez O. (2021) Association between thyroid autoimmunity and ovarian reserve in women with hypothyroidism. Thyroid Res, 14(1):6.
- 18. Krassas GE, Poppe K, Glinoer D. (2021) Thyroid function and human reproductive health. Endocr Rev, 31(5):702–55.
- 19. Gawlik A, Malecka-Tendera E. (2014) Transition In Endocrinology: Treatment of Turner’s syndrome during transition. Eur J Endocrinol, 170(2):R57–74.
- 20. Grossi A, Crinò A, Luciano R, Lombardo A, Cappa M, Fierabracci A. (2013) Endocrine autoimmunity in Turner syndrome. Ital J Pediatr, 39:79.
- 21. Fukuda I, Hizuka N, Kurimoto M. (2009) Autoimmune thyroid diseases in 65 Japanese women with Turner syndrome. Endocr J, 56(8):983–6.
- 22. Monteleone P, Parrini D, Faviana P (2011) Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol, 66(2):108–14.
- 23. Saglam F, Onal ED, Ersoy R. (2015) Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease. Gynecol Endocrinol, 31(2):165–8.
- 24. Chen C-W, Huang Y-L, Tzeng C-R, Huang R-L, Chen C-H. (2017) Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid, 27(9):1194–200.
- 25. Ke H, Hu J, Zhao L, Ding L, Jiao X, Qin Y. (2020) Impact of thyroid autoimmunity on ovarian reserve, pregnancy outcomes, and offspring health in euthyroid women following in vitro fertilization/intracytoplasmic sperm injection. Thyroid, 30(4):588–97.
- 26. Osuka S, Iwase A, Goto M (2018). Thyroid autoantibodies do not impair the ovarian reserve in euthyroid infertile women: a cross-sectional study. Horm Metab Res, 50(07):537–42.
- 27. Kuroda M, Kuroda K (2018) Levothyroxine supplementation improves serum anti‐Müllerian hormone levels in infertile patients with Hashimoto’s thyroiditis. J Obstet Gynaecol Res, 44(4):739–46.
- 28. Fanchin R, Taieb J, Lozano DHM, Ducot B, Frydman R, Bouyer J. (2005) High reproducibility of serum anti-Müllerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status. Hum Reprod, 20(4):923–7.
- 29. Moslehi N, Shab-Bidar S, Tehrani FR, Mirmiran P, Azizi F. (2018) Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause, 25(9):1046–55.
- 30. Hollowell JG, Staehling NW, Flanders WD (2002). Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab, 87(2):489–99.