The impact of thyroid function on fertility and pregnancy is an important and current topic, but not always adequately explored, which has led the Gat patient association, Gruppo Aiuto Thyroide, thanks to the support of the Con Il Sud Foundation, to collect the most updated scientific evidence on the topic. “The need to focus attention on these issues – explains Annunziata Bellavista, president of the association – arose from the observations that emerged during the activities carried out in schools every year”.
Female fertility “is guaranteed by the complex interaction between hormonal, gynecological and anatomical factors, which together ensure the regularity of the menstrual cycle and ovulation and the creation of a uterine environment suitable for the implantation and growth of the embryo – explains Francesco Giorgino , full professor of Endocrinology, director of Endocrinology at the Bari Polyclinic – Hormonal alterations can break this balance and compromise fertility and the continuation of pregnancy. In particular, the thyroid hormones T3 and T4 are involved in the regulation of numerous functions in the body. including the regulation of the menstrual cycle and ovulation”.
“Thyroid hormones are fundamental for women starting from adolescence up to menopause; estrogens are able to modulate thyroid function and thyroid function is fundamental for human reproduction – continues Rossella Nappi, full professor of Obstetrics and Gynaecology, responsible Ssd Obstetrics and Gynecology 2 – Pma San Matteo Hospital Pavia – Often the gynecologist becomes the first line doctor in intercepting thyroid dysfunctions and, in synergy with the endocrinologist, treats them in adolescence, for example. of the estrogen-progestin pill can have an impact on thyroid function, since it induces alterations, albeit modest, in the free quotas of thyroid hormones, but the period of the woman’s life in which an evaluation of thyroid function is important is the pre-conceptional and peri-conceptional phase. conceptual, because many studies have shown that suboptimal thyroid function is responsible for menstruation irregularities and ovulation problems”.
In general, “the prescription of hormonal therapies, whether contraceptive or fertility – adds Nappi – should be associated with monitoring of thyroid function, particularly in patients with known thyroid disease. Even a woman with a regular, fertile, ovulatory menstrual cycle , but with a thyroid that is not perfectly in place, it can lead to a greater risk of miscarriage and reproductive failure due to mechanisms that are still partly to be clarified.”
“Particular attention – continues the gynecologist – must be given to pregnancies that begin with a normal thyroid function, but with a profile of inflammation, therefore of autoantibodies, the so-called Hashimoto’s thyroiditis; this condition can lead to a non-optimal start to the pregnancy , with the risk of forming a less efficient future placenta. It can lead not only to a greater risk of miscarriage, but also the risk of developing a real placental insufficiency which can be associated with arterial hypertension, premature birth, low birth weight. And this is why the measurement of pre-conception Tsh, of the basic antibodies, the so-called Tpo, is recommended to intervene promptly in the event of pregnancy. In assisted reproduction centers, sometimes, the thyroid hormones are corrected preventively with very low doses of thyroid hormone. patients who undergo ovarian stimulation on the basis of important studies that confirm the validity of this intervention”.
As always, “prevention is fundamental and this can be done through the intake of iodine – underlines Giorgino – An adequate intake of iodine, in fact, is essential to guarantee the correct functioning of the thyroid, since iodine is a necessary component for synthesis of thyroid hormones. Therefore, iodine prophylaxis can influence thyroid health and in concert the fertility of women by preventing thyroid dysfunction and improving fertility. An adequate intake of iodine is necessary to prevent iodine deficiency, which is among the main causes of thyroid disorders, such as hypothyroidism and goiter. Maintaining appropriate iodine levels promotes optimal thyroid function, which helps improve fertility.” But not only that, “it can also reduce the risk of complications during pregnancy: iodine prophylaxis can reduce the risk of complications resulting from iodine deficiency during pregnancy, such as hypothyroidism or mental retardation in the fetus – remarks the endocrinologist – This can contribute to a healthier pregnancy and better maternal-fetal and neonatal health. And finally, iodine prophylaxis can help reduce the risk of spontaneous abortions.
“It is important to underline that even excess iodine can be harmful – explains Giorgino – as much as its deficiency. Therefore, it is essential to maintain a balance in iodine intake and not exceed the recommended doses, especially during pregnancy and Therefore, women of childbearing age should consult their doctor regarding the need for iodine supplementation. It should be noted that iodine prophylaxis can affect thyroid health and male fertility in a similar way as it does in women. effects are less clear and less explored in humans”.
“Surveillance of the state of iodine nutrition is a concrete action in favor of the well-being of the general population and of Apulian women in particular”, observes Daniela Agrimi, head of the Orpg Regional Observatory for the Prevention of Goiter-Puglia, with which the Gat has a close and fruitful collaboration. A final aspect concerns the “relationship between oncological therapies and the thyroid – Agrimi points out – The latest generation oncological therapies have demonstrated good efficacy in many types of tumors, so much so that their use has been approved for the therapy of various neoplasms (melanomas , lung cancer, kidney cancer, and blood cancers). One of the main problems related to the use of these classes of drugs is endocrine toxicity, which manifests itself with a reduction or excess of the hormonal function of the affected endocrine gland gland may be the subject of such toxicity, the thyroid is the most frequently affected organ (approximately 15% of cases), with a clinical picture that often consists of a reduced production of thyroid hormones, i.e. hypothyroidism usually 1-3 months after the start of therapy and may be preceded by a transitory period of hyperthyroidism, due to the excessive release of hormones into the blood by the affected thyroid. In addition to the thyroid, the pituitary gland, adrenal glands and endocrine pancreas may also be affected.”
Finally, according to Nappi “there is still a lot to study to support women in the stages of life, because menopause is also a time when the thyroid goes into reserve; we see a lot of sub-clinical hypothyroidism which contributes to the state of malaise of the woman during menopause, therefore correcting thyroid function and studying it is also important in women who are no longer fertile”.
#Experts #treating #thyroid #dysfunction #puts #pregnancy #risk