Reproduksi Dan Thyroid

REPRODUCTION & THE Supervised by :
THYROID
Prof. Dr. dr. Nusratuddin Abdullah, Sp.OG
(K), MARS
INTRODUCTION
•Thyroid gland is one of the largest of the endocrine organs, which is under the influence of TSH and
stimulated by TRH also produces hormone thyroxine (T4) and triiodothyronine (T3)
•Thyroid hormones also influence reproductive system, brain function, neural development, dentition, and
bone development
• TSH is one of glycoprotein hormone family which regulated multiple steps in thyroid hormone
production
•The functional unit of the thyroid gland is the thyroid follicle, surrounding a core of colloid which
consist thyroglobulin
Goodman, H. M. (2009). Pituitary Gland. Basic Medical Endocrinology, 29–42.doi:10.1016/b978-0-12-373975-9.00002-1
Fritz & Speroff. 2019. Clinical Gynecologic Endocrinology and Infertility 8 ed. LIPPINCOTT WILLIAMS & WILKINS.
th
Yen & Jaffe’s. 2018. REPRODUCTIVE ENDOCRINOLOGY PHYSIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT 8th ed. Elsevier.
PHYSIOLOGY
 Thyroid hormone synthesis depends in large part on an adequate supply of iodine in
the diet, then enters the thyroid under the influence of thyroid-stimulating hormone
(TSH).
Monoiodotyrosine and diiodotyrosine combine to form thyroxine (T4) and

triiodothyronine (T3) in follicular cell of Thyroid Gland which is regulated by TSH.
TSH induces a proteolytic process that results in the release of iodothyronines into the
bloodstream as thyroid hormone.
 Thyroid hormone for its normal operation, not only metabolism but also
development, steroidogenesis, and most specific tissue activities.
Fritz & Speroff. 2019. Clinical Gynecologic Endocrinology and Infertility 8 ed. LIPPINCOTT WILLIAMS & WILKINS
th
PHYSIOLOGY
• Thyroid hormones are 70% bound to thyroxine-binding globulin (TBG) & 30% bound
to thyroxine-binding prealbumin and albumin
•Thyroxine-binding globulin (TBG) is the liver-synthesized and estrogen-upregulated

major plasma carrier of thyroid hormones with an affinity binding greater for T4 than
T3
•Thyroid hormone has alpha receptor gene is on chromosome 17 and the beta receptor
gene is on chromosome 3
.
Fritz & Speroff. 2019. Clinical Gynecologic Endocrinology and Infertility 8 ed. LIPPINCOTT WILLIAMS & WILKINS
th
PHYSIOLOGY
In a normal adult, one third of the T4 secreted each
day is converted in peripheral tissues to T3, and about
40% is converted to the inactive (Reverse T3)
T3 is more potent T4 because the nuclear thyroid

receptor has a 10-fold greater affinity for T3 than T4
Goodman, H. M. (2009). Pituitary Gland. Basic Medical Endocrinology, 29–42.doi:10.1016/b978-0-12-373975-9.00002-1

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PHYSIOLOGY
 The thyroid axis is stimulated by the hypothalamic
factor, thyrotropin-releasing hormone (TRH), and
inhibited by somatostatin and dopamine
Pituitary secretion of TSH is very sensitive to

changes in the circulating levels of thyroid
hormone
TRH also stimulates prolactin secretion by the

pituitary
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WHAT CAN AFFECT THYROID
HORMONE
Estrogen, oral contraceptive pills, pregnancy, liver

disease, and hepatitis C virus infection are common
causes of increased thyroid hormone binding
proteins and will result in a high Total T4 Lesser effects are associated with dopamine agonists,
glucocorticoids and somatostatin
Fritz & Speroff. 2019. Clinical Gynecologic Endocrinology and Infertility 8th ed. LIPPINCOTT WILLIAMS & WILKINS.
THYROID FUNCTION TEST
THYROID TEST NORMAL VALUE
Free Thyroxin 4 (FT4) 0.8–2.0 ng/dL Free T4 are usually displacement assays using an
Total Thyroxin 4 (TT4) 5–12 mcg/dl antibody to T4 and not affected by changes in
Free Thyroxin Index 6–11.00 μg/dL
(FTI/T7) TBG and binding.
Total T3 & Reverse T3 80-220 ng/dL & 250
pg/ml (10 to 24 ng/dL) TSH is a very sensitive indicator of thyroid
Thyroid Stimulating 0.45–4.5 mU/mL hormone action at the tissue level because it is
Hormone (TSH)
TSH Receptor Antibody <140% of basal activity dependent on the pituitary exposure to T4.
Radioactive Iodine 6 hours: 3 to 16%
Uptake Scan 24 hours: 8 to 25%
CHANGE IN THYROID
FUNCTION TEST
Burkman RT. Endocrine Disorders. Berek & Novak’s Gynecology. JAMA. 2012
THYROID DISORDERS AND
REPRODUCTION
 Diseases of the thyroid are more common in
women than men, most of them are autoimmune
disease
 Despite the importance of thyroid hormone in

maintaining normal organ and endocrine function
throughout the body, the exact mechanisms for
thyroid hormone’s effects are not well understood
Yen & Jaffe’s. 2018. REPRODUCTIVE ENDOCRINOLOGY PHYSIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT 8th ed. Elsevier
HYPOTHYROID
 Low FT4, High TSH
 Elevated TRH can stimulate lactotrophs to produce prolactin, which

interferes with GnRH pulsatility  Amenorrhea
 Hypothyroidism reduces SHBG binding affinity which rarely lead to

unopposed estrogen  Menorrhagia
 T4 has been shown to stimulate ovarian steroidogenesis in granulosa

cells by altering the activity of hormone synthesis related protein 3β-
HSD and CYP19
Gaberschek. S. 2015 Thyroid and polycystic ovary syndrome. European Jurnal&endocrinology Volume 172. https://doi.org/10.1530/EJE-14-0295
Yen & Jaffe’s. 2018. REPRODUCTIVE ENDOCRINOLOGY PHYSIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT 8th ed. Elsevier
TREATMENT HYPOTHYROID
 Initial therapy is straightforward with synthetic thyroxine, T4, given daili, the initial
dose should be 25–50 mg/day for 4 weeks
 The dose required will be close to 1.5 mg/lb body weight, but it may be less in very
old women
 Recovery of the hypothalamic-pituitary axis usually requires 8 weeks at which time

the TSH and free T4 levels can be measured
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HYPERTHYROID
 High FT4, low TSH
Hyperthyroidism is associated with increased SHBG (elevated testosterone

& estrogen concentrations)
 Elevated LH serum but decrease mid cycle LH surge
Abnormalities in basal and stimulated gonadotropins have been observed

in women with hyperthyroidism
Oligomenorrhea and amenorrhea may be more common in women with

hyperthyroidism but less evidence of ovulatory dysfunction and infertility.
Gaberschek. S. 2015 Thyroid and polycystic ovary syndrome. European Jurnal&endocrinology Volume 172. https://doi.org/10.1530/EJE-14-0295
TREATMENT HYPERTHYROID
 Anti thyroid treatment with a thionamide typically propylthiouracil (PTU) from 50
mg tid to 100 mg qid or methimazole 5 to 40 mg per day in one or two divided doses
 Radioactive iodine-131 ablation is an alternative to antithyroid agents for

hyperthyroidism (aside from thyroiditis)
 Surgery—thyroidectomy or resection of a toxic adenoma— is generally reserved

for treating hyperthyroidism in disease refractory to medical therapy
Yen & Jaffe’s. 2018. REPRODUCTIVE ENDOCRINOLOGY PHYSIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT 8 th ed. Elsevier.
FUNCTIONAL CHANGES WITH
AGING
 Thyroxine metabolism and clearance decrease in older people
 With aging, conversion of T4 to T3 decreases, and TSH levels increase.
 TBG concentrations decrease slightly in postmenopausal
THYROID AND PREGNANCY
Pregnancy-related changes in thyroid function include :
(1) relative maternal iodide deficiency and resultant increase in volume of the thyroid gland
by 10% to 20%;
(2) increase in maternal serum concentration of TBG
(3) increased circulating total T3 and T4
(4) decreased serum TSH concentration in the first trimester.
THYROID IN PREGNANCY
 Fetal thyroid begins to concentrate iodine at 9 to 10 weeks’ gestation; TBG and T4 are
first detected in fetal serum at 10 to 12 weeks’ gestation
 Maternal hyperthyroidism in pregnancy is associated with adverse maternalfetal

outcomes and the mainstay of therapy remains thionamide of maternal hyperthyroidism
in pregnancy.
 Maternal hypothyroidism in pregnancy with early identification and treatment with

levothyroxine or other thyroid hormone can ameliorate maternal and fetal risks.
THANKYOU

Reproduksi Dan Thyroid

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Reproduksi Dan Thyroid

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REPRODUCTION & THE Supervised by :

Monoiodotyrosine and diiodotyrosine combine to form thyroxine (T4) and

•Thyroxine-binding globulin (TBG) is the liver-synthesized and estrogen-upregulated

T3 is more potent T4 because the nuclear thyroid

Goodman, H. M. (2009). Pituitary Gland. Basic Medical Endocrinology, 29–42.doi:10.1016/b978-0-12-373975-9.00002-1

Pituitary secretion of TSH is very sensitive to

TRH also stimulates prolactin secretion by the

Estrogen, oral contraceptive pills, pregnancy, liver

 Despite the importance of thyroid hormone in

 Elevated TRH can stimulate lactotrophs to produce prolactin, which

 Hypothyroidism reduces SHBG binding affinity which rarely lead to

 T4 has been shown to stimulate ovarian steroidogenesis in granulosa

 Recovery of the hypothalamic-pituitary axis usually requires 8 weeks at which time

Hyperthyroidism is associated with increased SHBG (elevated testosterone

 Elevated LH serum but decrease mid cycle LH surge

Abnormalities in basal and stimulated gonadotropins have been observed

Oligomenorrhea and amenorrhea may be more common in women with

 Radioactive iodine-131 ablation is an alternative to antithyroid agents for

 Surgery—thyroidectomy or resection of a toxic adenoma— is generally reserved

 With aging, conversion of T4 to T3 decreases, and TSH levels increase.

 TBG concentrations decrease slightly in postmenopausal

(2) increase in maternal serum concentration of TBG

(3) increased circulating total T3 and T4

(4) decreased serum TSH concentration in the first trimester.

 Maternal hyperthyroidism in pregnancy is associated with adverse maternalfetal

 Maternal hypothyroidism in pregnancy with early identification and treatment with

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