Международный эндокринологический журнал 6 (54) 2013

Pubertal uterine bleedings are a topical problem of modern adolescent gynecology. As a rule, in case of disturbances of the menstrual cycle in girls in the form of pubertal menorrhagias the hormonal background changes, the synthesis and secretion of the gonadotropic hormones is disturbed, the secretion of estradiol and progesterone changes. Thyroid hormones exert an immediate effect on the organs of the reproductive system, inhibiting the follicle­stimulating function and enhancing the luteinizing function of the hypophysis and in its turn, the sensitivity of the ovaries to the gonadotropic hormones and the endometrium to estrogens increases.

Aim and object of the research. We have studied the concentration of the sex and thyroid hormones of the serum in the blood of teen­age girls, suffering from pubertal menorrhagias against a background of the thyroid gland pathology.

Material and methods of the research. We have examined 70 adolescent girls with pubertal menorrhagias who were treated at the gynecological unit of Municipal Clinical Maternity Hospital № 1 (MCMH № 1) of Chernivtsy City and subdivided into two groups: group I (basic) — 30 teen­age girls with the diagnosis of pubertal menorrhagias with underlying concomitant pathology of the thyroid gland, group II (of comparison) — 40 teen­age girls with the diagnosis of pubertal menorrhagias, 27 apparently healthy teen­age girls (the control group).

All the subjects underwent a multimodality hormonal examination with an evaluation of the concentration of hormones in the blood serum by means of the immune enzyme analysis (IEA) method, using the immunoenzymatic microplate semiautomatic analyzer — Expert Plus Asus, (Biochrom Ltd, England) and anassay kit VECTOR Best (Russia). Statistical data processing was carried out by means of a package of computer programs Statistica 6,0. Just this very investigation of sex hormones as estradiol (E2), progesterone (P), follicle­stimulating hormone (FSH), luteinizing hormone (LH) and thyroid hormones — thyroxine (T₄), triiodothyronine (T₃) and thyrotropin–releasing hormone (TRH) was assumed as the basis for the purpose of studying their concentration in the blood serum in teen­age girls with pubertal menorrhagias with concomitant pathology of the thyroid gland.

Results of the research and their discussion. A study of the indices of the hormonal profile of teen­age girls have shown that the concentration of estradiol elevated 1,14 times, FSG­1,32 times, T₃ — two times, T₄ — 1,17 times, TRH — 1,26 times upon admission for an inpatient examination, the level of progesterone essentially decreases by 27,08 % and LH 1,11 times.

Analyzing the concentration of the hormones of the thyroid gland (T₃, T₄, TRH, an essential decline of their concentration is marked in the blood serum as compared with the control group (< 0,05). The above — mentioned changes in their turn, result in a relative hyperestrogenia that is a pathogenetic mechanism for the development of metrorrhagias in the adolescent girls of group II.

We have studied the concentration of the blood serum hormones in girls (n = 30) with pubertal menorrhagias against, a background of thyroid gland pathology. The obtained findings have demonstrated that a clear­cut tendency is formed towards a decrease of the concentration of E2 — 1,7 times and progesterone — 2,11 times (> 0,05) and an increase of the level of FSH and LH — 3,28 times and 1,5 times respectively (> 0,05). A clear­cut imbalance of the thyroid hormones manifested by a sharp elevation of the T₃ level and a decrease of the T₄ concentration — 1,17 times (< 0,05) and TRH — 1,02 times (> 0,05) in the blood serum has been detected. It has been astablished that an imbalance of the thyroid hormones in the girls of the 1st group influences directly on the sexual glands, elevates the sensitivity to the gonadotropic hormone of the ovaries and the endometrial to the estrogens, the latter reflecting negatively on the forming of the menstrual cycle and the development of pubertal menorrhagias later on with underlying thyroid gland pathology.

Conclusions. Thus, the above mentioned changes point out to the fact that concomitant pathology of the thyroid gland is a pathogenetic basis of the clinical manifestations of hypothyroidism and autoimmune thyroiditis, disturbs the energy metabolism due to a deficiency of the principal thyroid hormones, resulting in a decrease of the basal metabolism. Owing to metabolic changes there occur impaimentsof the functioning of the ovariomenstrual cycle in teen­age girls, contributing to the development of dysfunctional metrorrhagias.