Ramesan C1, Unnikrishnan E2, Firozbabu K3
BACKGROUND
Primary hypothyroidism is the decrease in production and secretion of thyroid hormones by the thyroid gland. This is characterised by slackening of metabolism and leading to multiple system impairment. The important aetiological factors for primary hypothyroidism are congenital, iodine deficiency, autoimmune thyroiditis and iatrogenic.[1] Ovarian cysts are a common cause for gynaecological surgeries. The aetiology[2] of ovarian cysts can vary greatly including benign or malignant tumours, endometriosis and inflammation, etc. However, some cysts are direct result of endocrine disorders and do not require surgery. Hypothyroidism may cause reproductive and endocrinological disorders as well. The aetiopathogenesis is complex. In 1960 Van Wyk and Grumbach first described the relation between ovarian cyst and hypothyroidism. They proposed that there was a hormonal overlap in the pituitary feedback mechanism. It is due to the fact that TSH, GH, FSH and LH are all glycoproteins with a common alpha chain and may thus cross react. High TSH could produce FSH and LH like activity leading to luteinised ovarian cyst. The TRH may also act on pituitary cells to stimulate gonadotropin release and hence FSH and LH. Other postulated mechanisms are increased ovarian sensitivity to gonadotropins, altered metabolism of oestrogen, hypothalamopituitary dysfunction and altered prolactin metabolism.
AIMS
To study the percentage of ovarian cyst among the diagnosed cases of primary hypothyroidism and then to find out the association between hypothyroidism and ovarian cyst. To study the relation between level of TSH and size of ovarian cyst. To study the percentage of ovarian cyst among patients with TSH <50 mIU/L between 50-100 and >100 mIU/L separately.
SETTINGS
Study Design: Descriptive: Cross-sectional study.
Duration: One year.
Period: March 2013 to February 2014.
Sample Size: 100.
Study Area: Government Medical College, Calicut.
INCLUSION CRITERIA
Female patients of age more than 12 years presenting to Surgery/Medicine/Gynaecology OPD with clinical features of hypothyroidism and biochemical values of TSH >6.0 mIU/L.
EXCLUSION CRITERIA
Less than 12 years of age. Fully treated cases of hypothyroidism. Patients on hormonal therapy. Patients who are known cases of PCOS/FSH/LH/GH and GNRH abnormalities. Postmenopausal patients.
PROCEDURE
The patients presenting to Surgery/Medicine/Gynaecology Departments with clinical features of primary hypothyroidism and high serum TSH level (TSH>6 mIU/L) are evaluated with USG ABDOMEN AND PELVIS to detect ovarian cysts. After satisfying inclusion criteria, consent is taken and patients are included in the study and statistical analysis done.
STATISTICAL METHOD
SPSS 18 software for data analysis.
RESULTS
33% of the patients were detected to have various types of ovarian cysts like simple cyst, complex cyst and bilateral multicystic ovaries. Of these, majority was simple ovarian cyst and the complex cysts were seen only in 12% of the study group.
CONCLUSION
Most common clinical presentation of patients with primary hypothyroidism is lethargy/fatigue and simple ovarian cyst is the most common type of cyst occurring in association with primary hypothyroidism. The occurrence of ovarian cyst was significantly higher in those patients suffering from severe primary hypothyroidism (p value <0.005).
