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What is the relation between thyroid and irregular periods ?

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Internal Medicine Specialist
Practicing since : 1998
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Hello Doctor,

My wife is 33 years old and she is having irregular periods for last 7 months.

When we consulted our doctor, she asked us to take TSH and FSH tests on the 3rd day of her periods.

So far we have taken these tests 3 times. Please find the test results.

11-June-2011 (3rd day Morning after breakfast) TSH - 12.250 micIU/ml, FSH - 31.8 mIU/ml
08-July-2011 (4th day Morning after breakfast) TSH - 9.670 micIU/ml, FSH - 5.3 mIU/ml,
20-Aug -2011 (3rd day evening at 6PM) TSH - 3.290 micIU/ml, FSH - 15.8 mIU/ml,

All these test were taken WITHOUT any medication.

After first test result (11-June-2011), our doctor told that she has thyroid disorder and she is approaching earlier menopause.

My wife started taking more fruits and she IS YET TO START THYROID MEDICINE.

Based on the results, we observe that her thyroid TSH levels have come down but we see much variation in FSH levels. (31.8 - 5.3 - 15.8).

My questions are

1. why such a variation in FSH?. Does it indicate any specific health issue?. Nowadays she is getting periods after just 20 days.
2. Since TSH levels have gone down gradually, my wife's thyroid levels are becoming NORMAL now?.
3. Do we need to take these tests (TSH/FSH) with fasting?. Or is there any other procedure we need to follow?.

Please clarify our doubts. Thanks.

Regards
Sam
Posted Sun, 15 Apr 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Jasvinder Singh 30 minutes later
Hello XXXXXXX

Thanks for posting your query.

Normal range of the TSH levels should be between 0.4-4 mIU/L. With the variation in TSH levels, it can be due to subclinical hypothyroidism which is a mild form of hypothyroidism that has no apparent symptoms. Investigations show high levels of TSH and normal free T4 levels and hence it is important to get T3, T4 and TPO antibodies done for your wife.

If the TSH levels are >10, then we usually start the thyroid replacement therapy. If the levels are between 5-10, this is a grey zone. In such a scenario, we ask for the TPO antibodies or anti TG antibodies and if they are raised, we start the thyroid replacement therapy. So until and unless these tests are done, we cannot call the thyroid as Normal.

Regarding, FSH levels, definitely they are on the higher side in your wife’s case. In women with high FSH levels, the differential diagnosis is either ovarian failure or gonadotroph adenoma. We do the LH levels (leutinizing hormone) and in women with ovarian failure, both FSH and LH levels rise. In women with gonadotroph adenomas, FSH levels are usually high, but LH levels remain within reference ranges. So best is to get your wife’s LH levels also done.

If premature ovarian failure is confirmed by the LH levels, then assessment for autoimmune disorders, including thyroid or adrenal disease, is important to be done. Testing may include TSH (already done in your wife’s case), antithyroid antibodies, morning serum cortisol, and ACTH evaluations, followed by an ACTH stimulation test.

No fasting is required for FSH and TSH levels. FSH is done on specific days during your cycle (usually day 3 but can be done on day 2 or 4 also).

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you a good health.

Regards
Above answer was peer-reviewed by
 
Follow-up: What is the relation between thyroid and irregular periods ? 18 hours later
Hello Doctor,

Thank you very much for the very detailed clarification.

We have some more doubts. Please clarify.

1. Now we will take TSH, T3, T4, TPO Antibodies tests
Do we need to take Anti TG Anitbody test also?.

My wife is keep on postponing to take thyroid tables and she wants to control it by taking more fruits and on diet. Will it really work?. Or it will cause any other health issue?.

2. First time we took FSH, LH, PROLACTIN and TSH. The results are

11-June-2011 (On 3rd day of her cycle) FSH - 31.8 mIU/ml, LH - 11.4 mIU/ml, Prolactin(ECLIA) - 12.9 ng/ml, TSH - 12.250 micIU/ml.

We consulted our doctor and she told LH nevels and prolactin levels are normal but FSH and TSH were above the normal values.

Since LH level is normal, FSH variation could be because of gonadotroph adenomas?. Do we need to take any test to confirm the same?.

3. Also we are planning for a baby. Is it possible for her to conceive?.

Thanks & Regards
Sam




 
 
Answered by Dr. Jasvinder Singh 15 hours later
Hello,

Thanks for writing back.

Yes all these tests i.e. T3, T4, REPEAT TSH, TPO antibodies and Anti TG Antibody test should be done.

1)Thyroid disease cannot be controlled by diet alone and your wife needs to take the thyroid medication that will be prescribed regularly.

2) Gonadotroph adenomas are the most common pituitary macroadenomas but are the hardest to recognize. For the diagnosis, serum levels of glycoprotein hormones and/or free subunit levels, typically alpha-subunit and FSH-beta and TRH test can be done. You can talk to her gynecologist regarding these tests.

3) It is very difficult to forecast whether she will be able to conceive because thyroid disease/ premature ovarian failure and gondaotrophic adenomas are all hindrances of conceiving. However in such cases, IVF can be planned.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you a good health.

Regards
Above answer was peer-reviewed by
 
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