Menstrual Disorders and Main Indicators of Hormonal and Metabolic Homeostasis in Teenage Girls Against the Background of Endemic Goiter
Along with the widespread prevalence of goiter endemics, the medical and social significance of this problem is determined by the multifaceted spectrum of pathological abnormalities associated with asymptomatic course or hypothyroxinemia, causing numerous disorders at almost all stages of menstrual and reproductive function development.
The objective of the research was to substantiate and conduct a comprehensive analysis of the prevalence, structure and leading factors of dishormonal disorders of menstrual function in adolescent girls with diffuse endemic goiter, and to develop a diagnostic algorithm based on the risk of the formation of this pathology.
Materials and Methods. Two study groups were formed and a clinical laboratory examination was performed in 210 patients: 120 of them were diagnosed with menstrual dysfunction against the background of thyroid dysfunction (the main group); 60 girls were diagnosed with menstrual dysfunction and healthy thyroid gland (the comparison group); 30 apparently healthy girls made up the control group. Experimental and psychological methods, hormonal investigation of the level of thyroid, gonadotropic and steroid hormones, lipid and carbohydrate metabolism and vitamin D content in blood plasma were used.
Results and Discussion. Hypomenstrual syndrome, secondary amenorrhea, dysmenorrhea, manifestations of premenstrual syndrome and anovulatory conditions are the main menstrual disorders in adolescents suffering from endemic goiter. One third of the girls in the main group had an increase in the proportion of delayed sexual development, while in the control group, physiological rates of sexual development occurred in 96.7% of observations. The presented hormonal studies made it possible to identify differentiated changes taking into account different clinical forms of menstrual disorders in this category of patients. The transition to the “mature” type of reproductive system functioning in girls with endemic goiter is associated with changes in prolactin secretion from low levels to the indicators that exceed the reference values, which is characterized by increased functional hyperprolactinemia. Generalization of the frequencies of the main psycho-emotional characteristics and indicators of the personal profile in the girls of the studied cohort allowed revealing the constant dominance of psycho-emotional manifestations of moderate degree, as well as high levels of psycho-emotional stress and depressive disorders against the background of dishormonal disorders and thyroid gland dysfunction. Obtained deviations of 25-hydroxyvitamin D level were noticed at the initial stages of thyroid disorder, and low 25-hydroxyvitamin D levels contributed to the manifestation of thyroid pathology.
Conclusions. Dissociation of the thyroid system and the hypothalamic-pituitary-ovarian axis initiates menstrual disorders, development of functional cysts and multifollicular structure of the ovarian tissue, and, in case of hypothyroidism, is considered as a factor of metabolic disorders and polycystic ovary syndrome.
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