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Hyperthyroidism and Amenorrhea

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Question

My patient is 27 G1P1 desirous of pregnancy who stopped DepoProvera 1/05 and continues to be amenorrheic.

6/05 TSH =<0.03 and FT4=27.7

6/29/05 Scan = enlarged homogeneous gland c/w goiter

7/21/05 She received RAI

8/22/05 TSH=<0.03, FT4 = 0.80

She is not a patient patient and would like a specificidea of what to expect with regard to progress of thyroid function and, most specifically, when to expect resumption of menses and thereby return of fertility. Can I be more specific than “usually a few weeks or months after RAI…”? How often would you monitor her TFTs? Thank you for your service.

J.R. Hoffman M.D.,Jasper, IN

Response

She is just days from being seriously hyperthyroid, and is probably rapidly on her way to hypothyroidism. I would follow closely- at least monthly- and institute therapy unless she recovers promptly. Perhaps her amenorrhea is related to hyperthyroidism, perhaps not. Have you checked PRL? If there is no other cause, she is healthy, and she reaches stable euthyroidism soon, she should resume cycling in 2-4 months since she is only 27 and demonstrated prior fertility.

L De Groot,MD