Связь овариального резерва с аутоиммунными заболеваниями щитовидной железы в репродуктивном периоде
Связь овариального резерва с аутоиммунными заболеваниями щитовидной железы в репродуктивном периоде
Григорян О.Р., Красновская Н.С., Михеев Р.К. и др. Связь овариального резерва с аутоиммунными заболеваниями щитовидной железы в репродуктивном периоде. Терапевтический архив. 2019; 91 (10): 14–18. DOI: 10.26442/00403660.2019.10.000095
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Grigoryan O.R., Krasnovskaya N.S., Mikheev R.K., et al. Relationship of the ovarian reserve with autoimmune thyroid diseases in the reproductive period. Therapeutic Archive. 2019; 91 (10): 14–18. DOI: 10.26442/00403660.2019.10.000095
Связь овариального резерва с аутоиммунными заболеваниями щитовидной железы в репродуктивном периоде
Григорян О.Р., Красновская Н.С., Михеев Р.К. и др. Связь овариального резерва с аутоиммунными заболеваниями щитовидной железы в репродуктивном периоде. Терапевтический архив. 2019; 91 (10): 14–18. DOI: 10.26442/00403660.2019.10.000095
________________________________________________
Grigoryan O.R., Krasnovskaya N.S., Mikheev R.K., et al. Relationship of the ovarian reserve with autoimmune thyroid diseases in the reproductive period. Therapeutic Archive. 2019; 91 (10): 14–18. DOI: 10.26442/00403660.2019.10.000095
Цель исследования. Сравнить овариальный резерв у здоровых женщин репродуктивного возраста – носительниц антитиреоидных антител (АТА) – и у здоровых женщин репродуктивного возраста, негативных по АТА. Материалы и методы. Обследовано 70 здоровых женщин молодого репродуктивного возраста (от 18 до 38 лет) в состоянии эутиреоза. Участницы разделены на равные группы (n=35) в зависимости от статуса по наличию АТА (к тиреопероксидазе, тиреоглобулину). На 2–4-й день менструального цикла определяли следующие маркеры овариального резерва: сывороточные уровни антимюллерова гормона (АМГ), фолликулостимулирующего и лютеинизирующего гормонов, эстрадиола, тестостерона, а также ультразвуковые параметры – количество антральных фолликулов и объем яичников. Кроме того, для выяснения предрасположенности к преждевременной недостаточности яичников проводили анализ на количество CGG-повторов в гене FMR1. Результаты и обсуждение. Статистически достоверно различались такие параметры, как уровень эстрадиола и тестостерона, при этом различия не были клинически значимыми. Все оцениваемые параметры оказались в пределах нормы, основные показатели овариального резерва (уровень АМГ, количество антральных фолликулов) оставались в нормальном диапазоне. Увеличения количества повторов CGG в гене FMR1 не выявлено ни у одной из участниц исследования. Заключение. У здоровых женщины молодого репродуктивного возраста статус по АТА не оказывает непосредственного влияния на овариальный резерв.
Aim. To compare ovarian reserve in healthy women of reproductive age – carriers of antithyroid antibodies (ATA) and in healthy women of reproductive age negative for ATA. Materials and methods. 70 healthy women of young reproductive age in the state of euthyroidism (from 18 to 38 years old) were examined. Participants were divided into equal groups (n=35) depending on the status of the presence of antithyroid antibodies (AT-TPO, AT-TG). On the 2nd–4th days of the menstrual cycle, the following markers of the ovarian reserve were determined: serum levels of anti-Müllerian hormone (AMG), inhibin B, FSH, LH, estradiol, testosterone and progesterone, as well as ultrasound parameters – the number of antral follicles and the volume of the ovaries. In addition, to determine the predisposition to premature ovarian failure, an analysis was performed to the number of CGG repeats in the FMR1 gene. Results and discussion. Statistically significantly differs such parameters as the level of estradiol and testosterone, while the differences were not clinically significant. All the parameters evaluated were within the normal range, the main predictors of the ovarian reserve (levels of AMG and inhibin B, the number of antral follicles) remained in the normal range. An increase in the number of repeats of CGG in the FMR1 gene was not detected in any of the participants in the study. Conclusion. In healthy young reproductive age women, the status of ATA does not have a direct effect on the ovarian reserve.
1. Merrill SJ, Mu Y. Thyroid autoimmunity as a window to autoimmunity: An explanation for sex differences in the prevalence of thyroid autoimmunity. J Theor Biol. 2015;375:95-100. doi: 10.1016/j.jtbi.2014.12.015
2. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):153-65. doi: 10.1016/j.beem.2004.03.004
3. Mintziori G, Anagnostis P, Toulis KA, Goulis DG. Thyroid diseases and female reproduction. Minerva Med. 2012 Feb;103(1):47-62.
4. Боярский К.Ю., Гайдуков С.Н., Чинчаладзе А.С. Факторы, определяющие овариальный резерв женщины. Журнал акушерства и женских болезней. 2009;LVIII(2):65-71 [Boyarsky KYu, Gaidukov SN, Chinchaladze AS. Factors which can predict ovarian reserve. Zhurnal Akusherstva i Zhenskikh Boleznei = Journal of Obstetrics and Women's Diseases. 2009;LVIII(2):65-71 (In Russ.)].
5. Vigier B, Tran D, Legeai L, Bézard J, Josso N. Origin of anti-Müllerian hormone in bovine freemartin fetuses. J Reprod Fertil. 1984 Mar;70(2):473-9.
6. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217. doi: 10.1155/2016/5246217
7. Committee opinion no. 618: Ovarian reserve testing. Committee on Gynecologic Practice. Obstet Gynecol. 2015 Jan;125(1):268-73. doi: 10.1097/01.AOG.0000459864.68372.ec
8. Franks S. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. J Clin Endocrinol Metab. 2006 Mar;91(3):786-9. doi: 10.1210/jc.2005-2501
9. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):153-65. doi: 10.1016/j.beem.2004.03.004
10. Mintziori G, Anagnostis P, Toulis KA, Goulis DG. Thyroid diseases and female reproduction. Minerva Med. 2012 Feb;103(1):47-62.
11. Reh A, Grifo J, Danoff A. What is a normal thyroid-stimulating hormone (TSH) level? Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization. Fertil Steril. 2010 Dec;94(7):2920-2. doi: 10.1016/j.fertnstert.2010.06.041
12. Murto T, Bjuresten K, Landgren BM, Stavreus-Evers A. Predictive value of hormonal parameters for live birth in women with unexplained infertility and male infertility. Reprod Biol Endocrinol. 2013 Jul 11;11:61. doi: 10.1186/1477-7827-11-61
13. Krassas G, Perros P, Kaprara A. Thyroid autoimmunity, infertility and miscarriage. Expert Rev Endocrinol Metab. 2008;3(2):127-36. doi: 10.1586/17446651.3.2.127
14. Geva E, Lessing JB, Lerner-Geva L, Azem F, Yovel I, Amit A. The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. Am J Reprod Immunol. 1997 Feb;37(2):184-6. doi: 10.1111/j.1600-0897.1997.tb00210.x
15. Janssen O, Mehlmauer N, Hahn S, Offner A, Gartner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004;150(3):363-9. doi: 10.1530/eje.0.1500363
16. Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016 May 10;14(1):26. doi: 10.1186/s12958-016-0162-0
17. Tuten A, Hatipoglu E, Oncul M, Imamoglu M, Serdar A, Nevin Yilmaz A, et al. Evaluation of ovarian reserve in Hashimoto's thyroiditis. Gynecol Endocrinol. 2014;30(10):708-11. doi: 10.3109/09513590.2014.926324
18. Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecol Endocrinol. 2016;32(4):306-10. doi: 10.3109/09513590.2015.1116510
19. Murray A, Schoemaker MJ, Bennett CE, Ennis S. Population-based estimates of the prevalence of FMR1 expansion mutations in women with early menopause and primary ovarian insufficiency. Genet Med. 2014 Jan;16(1):19-24. doi: 10.1038/gim.2013.64. Epub 2013 May 23.
20. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015 Jul;30(7):1690-6. doi: 10.1093/humrep/dev089
21. Magri F, Schena L, Capelli V, Gaiti M, Zerbini F, Brambilla E, et al. Anti-Mullerian hormone as a predictor of ovarian reserve in ART protocols: the hidden role of thyroid autoimmunity. Reprod Biol Endocrinol. 2015 Sep 21;13(1):106. doi: 10.1186/s12958-015-0103-3
22. Grassi G, Balsamo A, Ansaldi C, Balbo A, Massobrio M, Benedetto C. Thyroid autoimmunity and infertility. Gynecol Endocrinol. 2001 Oct;15(5):389-96. doi: 10.1080/713602919
23. Geva E, Lessing JB, Lerner-Geva L, Azem F, Yovel I, Amit A. The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. Am J Reprod Immunol. 1997 Feb;37(2):184-6. doi: 10.1111/j.1600-0897.1997.tb00210.x
24. Kutteh W, Yetman DL, Carr AC, Beck LA, Scott RT Jr. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril. 1999;71(5):843-8. doi: 10.1016/s0015-0282(99)00091-6
25. Poppe K, Glinoer D, van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, et al. Thyroid dysfunction and autoimmunity in infertile women. Thyroid. 2002 Nov;12(11):997-1001. doi: 10.1089/105072502320908330
26. Abalovich M, Mitelberg L, Allami C, Gutierrez S, Alcaraz G, Otero P, et al. Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol. 2007 May;23(5):279-83. doi: 10.1080/09513590701259542
27. Poppe K, Glinoer D, Tournaye H, Schiettecatte J, Devroey P, van Steirteghem A, et al. Impact of Ovarian Hyperstimulation on Thyroid Function in Women with and without Thyroid Autoimmunity. J Clin Endocrinol Metabol. 2004;89(8):3808-12. doi: 10.1210/jc.2004-0105
28. Lazzarin N, Moretti C, De Felice G, Vaquero E, Manfellotto D. Further evidence on the role of thyroid autoimmunity in women with recurrent miscarriage. Int J Endocrinol. 2012;2012:717185. doi: 10.1155/2012/717185
29. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011 Aug;66(2):108-14. doi: 10.1111/j.1600-0897.2010.00961.x
________________________________________________
1. Merrill SJ, Mu Y. Thyroid autoimmunity as a window to autoimmunity: An explanation for sex differences in the prevalence of thyroid autoimmunity. J Theor Biol. 2015;375:95-100. doi: 10.1016/j.jtbi.2014.12.015
2. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):153-65. doi: 10.1016/j.beem.2004.03.004
3. Mintziori G, Anagnostis P, Toulis KA, Goulis DG. Thyroid diseases and female reproduction. Minerva Med. 2012 Feb;103(1):47-62.
4. [Boyarsky KYu, Gaidukov SN, Chinchaladze AS. Factors which can predict ovarian reserve. Zhurnal Akusherstva i Zhenskikh Boleznei = Journal of Obstetrics and Women's Diseases. 2009;LVIII(2):65-71 (In Russ.)].
5. Vigier B, Tran D, Legeai L, Bézard J, Josso N. Origin of anti-Müllerian hormone in bovine freemartin fetuses. J Reprod Fertil. 1984 Mar;70(2):473-9.
6. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217. doi: 10.1155/2016/5246217
7. Committee opinion no. 618: Ovarian reserve testing. Committee on Gynecologic Practice. Obstet Gynecol. 2015 Jan;125(1):268-73. doi: 10.1097/01.AOG.0000459864.68372.ec
8. Franks S. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. J Clin Endocrinol Metab. 2006 Mar;91(3):786-9. doi: 10.1210/jc.2005-2501
9. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):153-65. doi: 10.1016/j.beem.2004.03.004
10. Mintziori G, Anagnostis P, Toulis KA, Goulis DG. Thyroid diseases and female reproduction. Minerva Med. 2012 Feb;103(1):47-62.
11. Reh A, Grifo J, Danoff A. What is a normal thyroid-stimulating hormone (TSH) level? Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization. Fertil Steril. 2010 Dec;94(7):2920-2. doi: 10.1016/j.fertnstert.2010.06.041
12. Murto T, Bjuresten K, Landgren BM, Stavreus-Evers A. Predictive value of hormonal parameters for live birth in women with unexplained infertility and male infertility. Reprod Biol Endocrinol. 2013 Jul 11;11:61. doi: 10.1186/1477-7827-11-61
13. Krassas G, Perros P, Kaprara A. Thyroid autoimmunity, infertility and miscarriage. Expert Rev Endocrinol Metab. 2008;3(2):127-36. doi: 10.1586/17446651.3.2.127
14. Geva E, Lessing JB, Lerner-Geva L, Azem F, Yovel I, Amit A. The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. Am J Reprod Immunol. 1997 Feb;37(2):184-6. doi: 10.1111/j.1600-0897.1997.tb00210.x
15. Janssen O, Mehlmauer N, Hahn S, Offner A, Gartner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004;150(3):363-9. doi: 10.1530/eje.0.1500363
16. Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016 May 10;14(1):26. doi: 10.1186/s12958-016-0162-0
17. Tuten A, Hatipoglu E, Oncul M, Imamoglu M, Serdar A, Nevin Yilmaz A, et al. Evaluation of ovarian reserve in Hashimoto's thyroiditis. Gynecol Endocrinol. 2014;30(10):708-11. doi: 10.3109/09513590.2014.926324
18. Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecol Endocrinol. 2016;32(4):306-10. doi: 10.3109/09513590.2015.1116510
19. Murray A, Schoemaker MJ, Bennett CE, Ennis S. Population-based estimates of the prevalence of FMR1 expansion mutations in women with early menopause and primary ovarian insufficiency. Genet Med. 2014 Jan;16(1):19-24. doi: 10.1038/gim.2013.64. Epub 2013 May 23.
20. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015 Jul;30(7):1690-6. doi: 10.1093/humrep/dev089
21. Magri F, Schena L, Capelli V, Gaiti M, Zerbini F, Brambilla E, et al. Anti-Mullerian hormone as a predictor of ovarian reserve in ART protocols: the hidden role of thyroid autoimmunity. Reprod Biol Endocrinol. 2015 Sep 21;13(1):106. doi: 10.1186/s12958-015-0103-3
22. Grassi G, Balsamo A, Ansaldi C, Balbo A, Massobrio M, Benedetto C. Thyroid autoimmunity and infertility. Gynecol Endocrinol. 2001 Oct;15(5):389-96. doi: 10.1080/713602919
23. Geva E, Lessing JB, Lerner-Geva L, Azem F, Yovel I, Amit A. The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. Am J Reprod Immunol. 1997 Feb;37(2):184-6. doi: 10.1111/j.1600-0897.1997.tb00210.x
24. Kutteh W, Yetman DL, Carr AC, Beck LA, Scott RT Jr. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril. 1999;71(5):843-8. doi: 10.1016/s0015-0282(99)00091-6
25. Poppe K, Glinoer D, van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, et al. Thyroid dysfunction and autoimmunity in infertile women. Thyroid. 2002 Nov;12(11):997-1001. doi: 10.1089/105072502320908330
26. Abalovich M, Mitelberg L, Allami C, Gutierrez S, Alcaraz G, Otero P, et al. Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol. 2007 May;23(5):279-83. doi: 10.1080/09513590701259542
27. Poppe K, Glinoer D, Tournaye H, Schiettecatte J, Devroey P, van Steirteghem A, et al. Impact of Ovarian Hyperstimulation on Thyroid Function in Women with and without Thyroid Autoimmunity. J Clin Endocrinol Metabol. 2004;89(8):3808-12. doi: 10.1210/jc.2004-0105
28. Lazzarin N, Moretti C, De Felice G, Vaquero E, Manfellotto D. Further evidence on the role of thyroid autoimmunity in women with recurrent miscarriage. Int J Endocrinol. 2012;2012:717185. doi: 10.1155/2012/717185
29. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011 Aug;66(2):108-14. doi: 10.1111/j.1600-0897.2010.00961.x
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская поликлиника №9» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
1 Endocrinology Research Centre, Moscow, Russia;
2 City clinic №9, Moscow, Russia;
3 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia