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Prevalence of Hypothyroidism - Symptoms and Treatment

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Hypothyroidism is the most common endocrinological problem affecting women, causing a defect in their ovulation process resulting in infertility.

Written byDr. Sebastian Denscy Mol

Medically reviewed byDr. Zulfiqar Ahmed

Published At February 15, 2023
Reviewed AtFebruary 15, 2023

Introduction:

Infertility is the inability to conceive even after a year of unprotected sexual intercourse. It is a widely prevalent issue affecting many couples globally. The thyroid gland releases thyroid hormones that affect pregnancy and reproduction. Untreated thyroid diseases like hypothyroidism and hyperthyroidism can cause infertility. Thyroid defects are more commonly seen in females than in males. Both hypothyroidism and hyperthyroidism affect infertility, cause an imbalance in sex hormones, menstrual abnormalities, and miscarriages, and can also cause delayed onset of puberty. Therefore, a normal thyroid gland is essential for fertility and healthy pregnancy. A female with a family history of thyroid issues, irregular menstrual problems, having had more than two or more abortions, or difficulty conceiving even after one year of unprotected sexual intercourse should undergo thyroid evaluations to test for any thyroid abnormalities.

What Is Hypothyroidism?

When the thyroid gland cannot produce and release enough thyroid hormones into the bloodstream, it causes hypothyroidism. Hormones released by the thyroid gland are thyroxine (T4) and triiodothyronine (T3). The anterior part of the pituitary gland releases another hormone called the stimulating thyroid hormone (TSH).

According to the hormone levels and symptoms, hypothyroidism is divided into subclinical hypothyroidism and clinical hypothyroidism. An increase in the thyroid stimulating hormone (TSH) levels with normal thyroxine (T4) and triiodothyronine (T3) suggests subclinical hypothyroidism, and an increase in TSH levels with low T4 and T3 levels suggests clinical hypothyroidism. Subclinical hypothyroidism is an early and milder form, whereas clinical hypothyroidism is the more severe form.

What Are the Symptoms of Hypothyroidism?

Symptoms of hypothyroidism can vary depending on the severity of the condition. Some of the symptoms include

  • Tiredness.

  • Weight gain.

  • Constipation.

  • Dry skin.

  • Muscle weakness.

  • Muscle stiffness, tenderness, and aches.

  • An irregular menstrual cycle that is heavier than usual.

  • Slow heart rate.

  • Memory problems.

  • Thinning and coarse hair and skin.

  • Depression.

What Causes Hypothyroidism?

Conditions that cause hypothyroidism include:

  1. Low Iodine - The thyroid gland needs the mineral iodine to make its hormones. Iodine is mainly found in seafood, plants grown in iodine-rich soil, iodized salt, and seaweed. A deficiency in iodine levels can lead to hypothyroidism.

  2. Pregnancy - Hypothyroidism can develop in a few pregnant women during or after pregnancy. If hypothyroidism occurs during pregnancy and is not treated, it can increase the risk of pregnancy loss and premature delivery of the child. Hypothyroidism also affects the developing fetus.

  3. Problems Present at Birth - Some babies are born with a malfunctioning thyroid gland.

  4. Autoimmune Disease - Hypothyroidism is caused mainly by an autoimmune disease called Hashimoto's. An autoimmune disease occurs when a person's immune system produces antibodies that attack the body's healthy tissues. Sometimes it involves the thyroid gland and affects the ability of the gland to produce its hormones.

  5. Thyroiditis - Thyroiditis is an inflammation of the thyroid gland which can occur due to an infection, autoimmune disorder, or any medical condition affecting the thyroid gland. Thyroiditis triggers the thyroid gland to release all its stored thyroid hormones. This causes a spike in thyroid activity called hyperthyroidism, and afterward, the thyroid becomes underactive, leading to hypothyroidism.

  6. Thyroid Surgery - If surgery removes part or all of the thyroid gland, it lowers the thyroid glands' ability to produce thyroid hormones.

  7. Radiation Therapy - Radiation therapy used to treat cancers of the head and neck region can affect the thyroid gland and its hormones.

How Is Hypothyroidism Associated With Infertility?

Hypothyroidism causes an increase in the production of thyrotropin-releasing hormone (TRH), which stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH) and prolactin levels (PRL). Increased prolactin levels cause hyperprolactinemia that affects fertility by impairing the gonadotrophin-releasing hormone (GnRH) and the functioning of the ovaries. The gonadotrophin-releasing hormone (GnRH) is a hormone that is produced by the pituitary gland. Gonadotrophin-releasing hormone (GnRH) stimulates the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are important for sexual maturity and reproductive health and produce the sex hormones estrogen, progesterone, and testosterone. A decreased gonadotropin-releasing hormone (GnRH) affects women's ovulation cycle and fertility.

What Is the Prevalence of Hypothyroidism in Infertile Women?

The prevalence of hypothyroidism in the reproductive age group of women ranges from about 2 percent to 4 percent and can cause infertility and abortion. Thyroid dysfunction affects fertility in various ways resulting in the following:

  1. Defects in Ovulation - Failure to produce a healthy ovum for fertilization.

  2. Defects in Luteal Phase - Luteal phase is a part of the menstrual cycle that occurs right after ovulation. It lasts 14 days and ends with the next period (menstruation cycle). A defect in the luteal phase of the menstrual cycle causes failure in the implantation of a fertilized egg. This failure ends up as vaginal bleeding, which is often mistaken as period blood but, in reality, is an early miscarriage.

  3. High Prolactin Levels - Increased thyroid-releasing hormone levels and decreased thyroxine levels result in irregular ovulation, absence, or lack of ovulation.

  4. Other Hormonal Imbalance - Hormonal imbalance like reduced sex hormone binding globulins, progesterone deficiency, and increased estrogen levels interferes with the reproductive hormonal balance of the body.

How Is Hypothyroidism Detected in an Infertile Couple?

  1. Couples' TSH and PRL levels are checked during initial infertility consultations.

  2. Hypothyroidism can be detected by assessing the levels of thyroid stimulating hormone (TSH) in the blood.

  3. Women planning to conceive should undergo thyroid screening for serum T3, T4, TSH, and thyroid antibodies, especially thyroglobulin and thyroid peroxidase.

  4. Thyroid antibody tests are not included in the basic fertility tests. It is done separately to identify the presence of thyroid antibodies. The presence of thyroid antibodies can double the risk of recurrent miscarriages in women with a normally functioning thyroid.

  5. The doctor checks every infertile woman's TSH and PRL levels regardless of their menstrual cycle.

What Are the Treatment Options for Infertility Associated With Hypothyroidism?

  1. A simple oral treatment was noted to change hypothyroidism significantly.

  2. Hormone therapy with thyroxine is the first-line treatment for established hypothyroidism. It normalizes the PRL levels and menstrual cycle and improves the fertility rate.

  3. In the presence of increased prolactin levels, it is recommended to treat hypothyroidism before evaluating any other cause for an increased prolactin level.

  4. Most infertile women were noted to conceive after six weeks to about one year of hormone therapy.

Conclusion:

Hypothyroidism is an emerging cause of infertility in women. It causes hormonal imbalances, affects ovulation, increases prolactin levels, and causes defects in the luteal phase in women of reproductive ages, thereby affecting their fertility. A simple thyroid profile test can easily diagnose infertility due to hypothyroidism, and infertility issues can be easily resolved with oral hormone therapy.

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Frequently Asked Questions

It is more frequently found in females than males. Approximately one in eight women have this condition at some point in their life. The risk is ten times higher in women than men. Thyroid diseases are more common in women than men because of the autoimmune nature of the thyroid gland. In autoimmune diseases, the immune cells start to attack their thyroid gland. 
Pregnancy and post-menopause are associated with a change in thyroid function. The other reason for hypothyroidism is there is an interplay between menstrual hormones and thyroid hormones. That is why women suffer from thyroid problems during menopause and pregnancy.
Both hyperthyroidism and hypothyroidism can be caused due to autoimmune diseases. An autoimmune disease is when the body’s immune system attacks the thyroid gland.  Hypothyroidism is an underactive thyroid gland with less thyroid hormone production. Hypothyroidism is more common than hyperthyroidism. The most common cause of hypothyroidism is Hashimoto’s thyroiditis, where the body’s immune system attacks its thyroid gland. Hashimoto’s thyroiditis occurs more frequently in women than men.
The prevalence of hypothyroidism in the reproductive age group of women ranges from about 2 percent to 4 percent and can cause infertility and abortion. 
Defects in Ovulation - Failure to produce a healthy ovum for fertilization.
The most common cause is that in most underdeveloped countries, people don't get enough iodine from food. Hypothyroidism is more common in women, and it affects more commonly women than men. 
Thyroid diseases are autoimmune and are more common in women. In autoimmune diseases, the body’s immune system attacks its cells. Hypothyroidism and thyroid nodules are most common in menopausal women. Thyroid fluctuations also occur in pregnancy. The most common cause of hypothyroidism is Hashimoto’s thyroiditis, where the body’s immune system attacks its thyroid gland. Hashimoto’s thyroiditis occurs more frequently in women than men.
There are 15 to 20 percent chances of genetic hypothyroidism. 2 to 5 percent of cases are inherited, and this condition also runs in families. In family thyroid disorders, autoimmune disorders have a genetic link. Both hyperthyroidism and hypothyroidism can be caused due to autoimmune diseases. An autoimmune disease is when the body’s immune system attacks the thyroid gland.  Hypothyroidism is an underactive thyroid gland with less thyroid hormone production. Hypothyroidism is more common than hyperthyroidism. 
Yes, hypothyroidism can occur in pregnancy because there are hormonal fluctuations during pregnancy and menopause. Hashimoto’s thyroiditis is the main cause of hypothyroidism in pregnant women. The immune system attacks its tissues and damages the thyroid gland. Due to complex hormonal changes in pregnancy and the requirement for thyroid hormones during pregnancy,  pregnant women are more prone to hypothyroidism.
In most cases, hypothyroidism is treated by replacing the missing hormone. Levothyroxine is the commonly used thyroid hormone. When taken orally, Levothyroxine increases the thyroid hormone levels in the body. If not treated appropriately, the symptoms of hypothyroidism can be severe, causing trouble breathing, development of mental health problems, heart problems, and enlargement of the thyroid gland (goiter).
Hypothyroidism is a lifelong condition where medication reduces the symptoms. The condition is best treated by using Levothyroxine. It will take a few years to relieve the symptoms. People should remain under medication for their entire life. The medications are adjusted accordingly after taking blood tests and routine follow-up. Once the hormones are replaced with Levothryxine, the symptoms gradually disappear.
Myxedema crisis, also called myxedema coma, is a severe form of hypothyroidism. It is a medical emergency where the body does not have sufficient thyroid hormones to carry out regular activities. 
 
The symptoms of myxedema coma are-
- Cold intolerance.
- Swelling of the face that includes eyelids and lips.
- Swelling and thickening of the skin.
- Low heart rate.
- Weight gain.
- Weakness.
- Brittle hair.
- High diastolic pressure.
- Mood swings.
- Depression.
In pregnant women, untreated thyroid disease can lead to miscarriage, stillbirth, and premature birth. The antibodies cross the placenta during pregnancy. During pregnancy, the baby is at risk for thyroid conditions after and during delivery. If the mother had Grave’s disease with radioactive iodine before pregnancy, then the baby is at risk for Grave’s disease (a disorder where there is an overproduction of thyroid hormones).
Yes, the condition is reversible. But in some cases, it is not permanently cured. The treatment for hypothyroidism is- Hormone therapy with Levothyroxine is the first-line treatment for hypothyroidism. They were noted to conceive after six weeks to about one year of hormone therapy. Levothyroxine is given orally to patients, increasing the body's thyroid hormone levels.
It is not rare. It affects five percent of the population. The risk factors for this condition are a family history of thyroid disease, being a woman, a history of thyroid surgery, and autoimmune diseases such as type 1 diabetes. Congenital hypothyroidism is a condition where hypothyroidism is present from birth. This condition occurs in 1 in 4000 newborns, affecting twice as many females as males.
The types of hypothyroidism are-
 
- Primary Hypothyroidism - It is the most common hypothyroidism where there is dysfunction of the thyroid gland.
- Central Hypothyroidism - It is divided into secondary and tertiary hypothyroidism. Secondary hypothyroidism occurs if there is dysfunction in the pituitary gland. Tertiary hypothyroidism is due to hypothalamus disorders. 
- Subclinical or Underactive Thyroid - Early form of thyroid failure.
- Congenital Hypothyroidism - It occurs at birth.
Hypothyroidism is prevalent in women, and it occurs typically between the ages of 20 and 40. It is more common in older women than younger. Both hyperthyroidism and hypothyroidism can be caused due to autoimmune diseases. An autoimmune disease is when the body’s immune system attacks the thyroid gland.  
Hypothyroidism is an underactive thyroid gland with less thyroid hormone production. Hypothyroidism is more common than hyperthyroidism. The most common cause of hypothyroidism is Hashimoto’s thyroiditis, where the body’s immune system attacks its thyroid gland. Hashimoto’s thyroiditis occurs more frequently in women than men.
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Dr. Zulfiqar Ahmed from iCliniq
Dr. Zulfiqar Ahmed

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