An Interview with Dr. Maha Behairi: The Thyroid Gland and Fertility
I recently had the pleasure to talk with Dr. Maha Behairi, a resident physician at the end of her specialty training in the Joint Program of Family Medicine. You can listen to the interview (at the bottom of this blog post) or read the questions I asked Dr. Maha and her response below.
Before delving into the interview, here’s a quick overview of the thyroid gland.
The Thyroid Gland and Its Function
The thyroid gland is a butterfly-shaped organ located at the base of your neck. It produces two hormones that are secreted into your blood: thyroxine (also called T4) and triiodothyronine (also called T3).
These hormones (T4 and T3) are necessary for the cells in your body to function normally. Additionally, these hormones regulate the rate at which life-sustaining chemical reactions in your body occur.
If your body secretes high levels of thyroid hormones, your body cells will work at a faster rate. In this case, you have hyperthyroidism (overactive thyroid). Some symptoms that are reported by hyperthyroid patients include palpitations (a sensation of a rapid, strong, or irregular heartbeat), frequent bowel movements, increased appetite, or heat intolerance.
Conversely, if your body produces too little of the thyroid hormones, your body cells will slow down. In this case, you have hypothyroidism (underactive thyroid). Your heart rate and bowel movements may slow down as a result. You may also experience weight gain, cold intolerance, or tiredness.
But what does the thyroid have to do with your fertility? This post will attempt to address this question.
The Thyroid Gland and Fertility Interview Questions
Dr. Maha was kind to answer your questions about the association between thyroid gland and fertility. Some of her responses were edited for brevity and clarity. To listen to the full interview, please click the button at the bottom of this blog post.
What infertility issues are associated with disorders of the thyroid?
Can thyroid disorders also affect male fertility?
I don’t think so. I think thyroid disorders affect only female fertility. When women are hypothyroid, their periods will be affected. They will have amenorrhea (abnormal absence of menstruation) and irregular periods, and their fertility can consequently be affected.
How can I know whether I have a problem with my thyroid gland?
According to current guidelines, screening for thyroid disorders is not recommended in pregnant women. However, thyroid function tests are performed in pregnant women who are known cases of hypo- or hyperthyroidism.
In non-pregnant women, the doctor will perform TFT (thyroid function tests) if the woman has signs and symptoms suggestive of thyroid disease such as irregular menstruation, amenorrhea, cold or heat intolerance, constipation or diarrhea, or difficulties in losing weight.
If I have a history of recurrent abortions, will I be tested for a thyroid disorder?
It depends on the case. Plus, there are many other factors that can cause recurrent abortions (e.g, antiphospholipid antibodies). However, we will certainly perform thyroid function tests in addition to other tests.
What treatment options are available for patients with thyroid disorders?
The treatment options depend on whether the patient has hypo or hyperthyroidism–Hashimoto’s thyroiditis, goiter, Grave’s disease. There is carbimazole for the treatment of hyperthyroidism and thyroxine for hyporthyroidism.
I have a thyroid problem. Are there any lifestyle changes that I should adopt to improve my fertility?
I think there is no strong evidence regarding the effect of lifestyle changes in women with thyroid problems. In the Asian population, there is a high rate of thyroid disorders (including cancers), which has been associated with iron intake.
(Have any studies been conducted in Saudi Arabia to investigate the effect of lifestyle changes on women with thyroid disorders?)
To the best of my knowledge, I don’t think any study has been conducted in Saudi Arabia to determine whether lifestyle changes can improve fertility in women with thyroid problems.
When you receive patients with infertility due to a thyroid problem, do they continue seeing their family medicine doctor while seeing a fertility specialist or consultant?
If a patient complains of infertility, we perform several lab investigations, including thyroid hormones, hormone profile, prolactin, etc, and if the patient has a thyroid problem, we will manage it.
If the patient doesn’t get pregnant despite adequate thyroid function, we will refer her to a fertility specialist. Even while the patient is seeing a fertility specialist, the family medicine specialist will follow up the patient to monitor her thyroid hormones and treatment.
For pregnant women, the family medicine department of our hospital typically prescribes treatment (we make dosage adjustments) before referring the patient to an endocrine clinic that specifically caters for pregnant women with thyroid diseases. The endocrine clinic is also responsible for following up the women during the entire pregnancy.
However, after delivery, the patient will be followed at the outpatient clinics of the family medicine department.
This post has been edited to correct a factually incorrect statement. It now reads “According to current guidelines, screening for thyroid disorders is not recommended in pregnant women.”