Severe Hypothyroidism Leading to Life Threatening Menorrhagia

Background: In their life-time, 10% to 30% of reproductive-aged women will experience abnormal uterine bleeding. After ruling out a pregnancy, the initial laboratory investigations for these patients should be based on history and clinical examination. Hypothyroidism and hyperthyroidism can be associated with abnormal uterine bleeding. Case: A 49 year-old woman was brought to the emergency department for abnormal uterine bleeding. Her hemoglobin was 26 g/L and her TSH and free thyroxin (T4) levels were >100 mU/L (0.25 to 5.00) and 1 ρmol/L (12 to 22), respectively. Oral levothyroxine was then started. High-doses of conjugated estrogen and tranexamic acid were used as needed to control uterine bleeding and the menorrhagia resolved rapidly. Conclusion: Severe hypothyroidism can lead to significant uterine bleeding secondary to ovulation and coagulation disorders.

Author(s):

Mathieu Viau, Marie-Claude Bussières, and Marie-Ève Bergeron

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