Sexual Dysfunction and Hyperthyroidism in Women

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Table of Contents

Evaluation Table
Summary of Findings
References

Evaluation Table

Citation
Andersen, S. L., Olsen, J., Wu, C. S., & Laurberg, P. (2014). Spontaneous abortion, stillbirth, and hyperthyroidism: A Danish population-based study. European Thyroid Journal, 3(3), 164-172.

Conceptual Framework
Case series, previous studies conducted in Denmark, and other countries were used as a theoretical basis.

Design/Method
Nationwide registers were used to identify pregnancies that led to hospital visits (spontaneous/induced abortion, molar/ectopic pregnancy, stillbirth).

Sample/Setting
The sample was 1,062,862 cases (all in Denmark).

Variables
Independent: The year of pregnancy termination, parity, cohabitation, maternal age, income, origin, residence.
Dependent: Hyperthyroidism influence on pregnancy outcome.

Measurement.
The Cox proportional hazards model.

Data Analysis
Statistics from the Danish National Hospital Register.

Findings
If maternal hyperthyroidism was diagnosed before/during pregnancy, spontaneous abortion was more frequent in treated and untreated women (aHR 1.28 (95% CI 1.18–1.40)/ 1.18 (1.07–1.31)) (Andersen et al., 2014, p. 164). Stillbirths were also more common in women with hyperthyroidism (2.12 (1.30–3.47)).

Appraisal/Worth to Practice
The study’s large sample size and use of recent evidence are its clear advantages. However, maternal thyroid hormones were not measured during the study.

Citation
Alamdari, S., Azizi, F., Delshad, H., Sarvghadi, F., Amouzegar, A., & Mehran, L. (2013). Management of hyperthyroidism in pregnancy: Comparison of recommendations of American thyroid association and the endocrine society. Journal of Thyroid Research, 2(1), 1-6.

Conceptual Framework
The study is based on previous research of Graves’ hyperthyroidism and its impact on pregnant women and fetuses.

Design/Method
The qualitative study design was used; the Guidelines of the American Thyroid Association and Endocrine Society Clinical Practice guidelines were reviewed for the study.

Sample/Setting
14 recommendations from the ATA guidelines and 13 recommendations from the ESCPG were used in the study (Alamdari et al., 2013).

Variables
Independent variables: recommendations from the ATA and ESCPG guidelines.

Measurement
The recommendations of the guidelines were compared in four distinct tables.

Data Analysis
The statistics included in the guidelines were used in the study.

Findings
No controversy was found in the guidelines. Propylthiouracil and methimazole were found to be the best drugs to treat the disease in the first trimester or the second trimester respectively.

Appraisal/Worth to Practice
The study can provide supporting information about the treatment of the disease. More guidelines could be included in the study to provide more accurate results. The study can be used as a guide by nursing professionals and future mothers.

Citation
Poppe, K., Hubalewska-Dydejczyk, A., Laurberg, P., Negro, R., Vermiglio, F., & Vaidya, B. (2012). Management of hyperthyroidism in pregnancy: Results of a survey among members of the European Thyroid Association. European Thyroid Journal, 1(1), 34-40.

Conceptual Framework
The study was based on previous researches and guidelines linked to Grave’s disease and hyperthyroidism in pregnant women.

Design/Method
An online questionnaire survey was emailed to 605 members of the European Thyroid
Association.

Sample/Setting
190 responses were used for analysis (Poppe et al., 2012). Participants were from 28 European countries.

Variables
Independent: Participants’ age, occupation, work experience, gender, race.
Dependent: Drugs used for the treatment of women with hyperthyroidism.

Measurement
Fisher’s exact test was used; statistical tests were considered significant if p < 0.05.

Data Analysis
The results of statistical tests that relied on the data provided by participants were used in the study.

Findings
78% of the responders suggested prescribing antithyroid drugs to women newly diagnosed with Grave’s disease. 22% recommended treatment with radioiodine
or surgery. For women with relapsed GD, 80% suggested definitive treatment.

Appraisal/Worth to Practice
Inconsistencies in the treatment of hyperthyroid in pregnant women exist despite the developed guidelines. A small sample size of the study is its disadvantage.

Citation
Andersen, S. L., Olsen, J., Carlé, A., & Laurberg, P. (2014). Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: A Danish population-based study. The Journal of Clinical Endocrinology & Metabolism, 100(3), 1164-1171.

Conceptual Framework
The study is based on previous retrospective studies conducted in different countries.

Design/Method
Population-based cohort study (Andersen et al., 2014).

Sample/Setting
403 958 women who gave birth to singleton liveborn children in Denmark were included in the sample size.

Variables
Independent: Age, income, origin, cohabitation, medicine prescribed for women with the disease.
Dependent: incidence of maternal hyperthyroidism and incidence of other autoimmune diseases.

Measurement
Statistical measurement was performed using STATA version 11.

Data Analysis
Statistic analyses were based on the data from the Danish Civil Registration System and the Medical Birth Registry (all women who gave birth to ≥1 singleton liveborn child in the period between 1999 and 2008).

Findings
Hyperthyroidism was more likely to occur in early pregnancy and postpartum; other autoimmune diseases did not follow this pattern.

Appraisal/Worth to Practice
The large sample size of the study is its main advantage. Additional research is needed to explain the incidence rate of Grave’s disease in early pregnancy.

Citation
Pasquali, D., Maiorino, M. I., Renzullo, A., Bellastella, G., Accardo, G., Esposito, D., & Esposito, K. (2013). Female sexual dysfunction in women with thyroid disorders. J Endocrinol Invest, 36(9), 729-33.

Conceptual Framework
The study is based on researches that examined the link between sexual dysfunction in women and thyroid diseases.

Design/Method
The prevalence of SD in women with thyroid diseases was evaluated by the authors of the study (Pasquali et al., 2013).

Sample/Setting
104 women with thyroid diseases (18 with hyperthyroidism) and 53 controls were included in the sample size.

Variables
Independent:age, residence, income, drugs prescribed.
Dependent: desire, arousal, satisfaction, lubrication, orgasm.

Measurement
The Female Sexual Function Index.

Data Analysis
Mean ± standard deviation (SD).

Findings
SD was more prevalent in women with thyroid diseases (46.1%).

Appraisal/Worth to Practice
The small sample size was the study’s weakness. However, its findings support the assumption that women with thyroid diseases are more likely to suffer from SD.

Summary of Findings

As the reviewed studies have shown, hyperthyroidism is often directly linked to reproductive problems in pregnant women or those women who are planning to become pregnant. Some of the studies show that hyperthyroidism can negatively influence different trimesters of pregnancy, as well as result in spontaneous abortions and stillbirths.

It should also be noted that although many guidelines about hyperthyroidism and its impact on pregnant women and fetuses exist, they are not aligned with each other. It does not mean, however, that they include contradictory information. They mostly provide supporting information about the condition and its causes.

Nevertheless, inconsistencies in the treatment of hyperthyroid still exist despite the developed guidelines. Different physicians and medical professionals prefer different methods and drugs to treat hyperthyroid. This finding supports the assumption that not all professionals use guidelines as supporting sources of information.

Hyperthyroidism was more likely to occur in early pregnancy or postpartum and did not correlate with other autoimmune diseases. However, additional research is needed to understand why hyperthyroidism was more likely to develop during the first trimester or after labor.

Hyperthyroidism was also linked to sexual dysfunctions in women; women with hyperthyroidism were less likely to experience orgasm, arousal, desire, and satisfaction. However, other thyroid disorders also adversely influenced the sexual function of women.

The findings of the five studies provide an insight into the treatment of hyperthyroidism, its impact on pregnancy, possible child loss, and other complications of childbirth. It seems reasonable to assume that early identification and treatment of hyperthyroidism can result in better pregnancy outcomes as well as less possible complications. Nevertheless, it should also be noted that several of these studies included small sample size and were limited in other options as well, which could adversely influence the outcomes.

Population studies, in return, have provided conclusive findings that indicate hyperthyroidism is specific for particular periods of pregnancy. The limitation of these population-based findings is that they did not have the opportunity to measure thyroid hormones in women. Moreover, it can also be assumed that age, other conditions and diseases, financial stability, and race can influence the development of hyperthyroidism. This possibility was not discussed in any of the reviewed studies.

Another problem that one of the studies has addressed is the inconsistency in the treatment of hyperthyroidism. If different physicians prefer different medications, it should be researched on how these preferences influence the development of hyperthyroidism and impact pregnant women and fetuses. However, the results of such a finding could indicate what treatment is more effective and why. This problem needs to be addressed more often in studies of hyperthyroidism.

The relation between female sexual dysfunction and hyperthyroidism is another issue that demands attention. In the provided study, female sexual dysfunction was examined in the context of thyroid diseases. However, additional studies need to focus on the direct influence of hyperthyroidism on sexual dysfunctions. This problem is rarely addressed, but it can give the researches a deeper understanding of the condition and its influences on female patients. Such research could also indicate whether there are other dysfunctions caused by hyperthyroidism that has not been addressed yet. Research on hyperthyroidism’s impact on childless women is scarce. Nevertheless, it does not mean that condition-based dysfunctions in these women are less valuable for the research of hyperthyroidism.

References

Alamdari, S., Azizi, F., Delshad, H., Sarvghadi, F., Amouzegar, A., & Mehran, L. (2013). Management of hyperthyroidism in pregnancy: Comparison of recommendations of American thyroid association and endocrine society. Journal of Thyroid Research, 2(1), 1-6.

Andersen, S. L., Olsen, J., Carlé, A., & Laurberg, P. (2014). Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: A Danish population-based study. The Journal of Clinical Endocrinology & Metabolism, 100(3), 1164-1171.

Andersen, S. L., Olsen, J., Wu, C. S., & Laurberg, P. (2014). Spontaneous abortion, stillbirth and hyperthyroidism: A Danish population-based study. European Thyroid Journal, 3(3), 164-172.

Pasquali, D., Maiorino, M. I., Renzullo, A., Bellastella, G., Accardo, G., Esposito, D., & Esposito, K. (2013). Female sexual dysfunction in women with thyroid disorders. J Endocrinol Invest, 36(9), 729-33.

Poppe, K., Hubalewska-Dydejczyk, A., Laurberg, P., Negro, R., Vermiglio, F., & Vaidya, B. (2012). Management of hyperthyroidism in pregnancy: Results of a survey among members of the European Thyroid Association. European Thyroid Journal, 1(1), 34-40.

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Sexual Dysfunction and Hyperthyroidism in Women

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