Excessive Uterine Bleeding in a Non-Compliant Patient With Profound Hypothyroidism: A Case Report and Review of the Literatures

Abstract

Studies suggest that dysthyroidism is associated with disturbances in female menstruation with hypothyroidism being associated with abnormal uterine bleeding. We report a case of excessive uterine bleeding due to severe hypothyroidism. The patient was a 35-year-old female with a history of papillary thyroid cancer, status post total thyroidectomy and subsequent two times of radioactive iodine treatment for residual thyroid cancer. She presented to emergency room two times in 4 days for persistent heavy vaginal bleeding. Her complete blood count (CBC) upon admission showed hemoglobulin (HgB) of 7.0 g/dL and hematocrit (HCT) of 20.0%. The patient admitted that she had not taken levothyroxine (LT4) for at least 4 weeks. The thyroid function test showed elevated thyroid-stimulating hormone (TSH) level of 74.71 mIU/L and decreased free T4 level of 0.55 ng/dL (reference range is 0.34 - 5.60 mIU/L and 0.58 - 1.64 ng/dL, respectively). The patient was given two units of packed red blood cell transfusion to correct the hemorrhagic anemia and then was given 25 mg of conjugated estrogen (Premarin) intravenously (IV) to control the bleeding. She was discharged on oral medroxyprogesterone acetate (Provera) and LT4 and was asked for regular follow-ups. This is an uncommon but representative case of acute menstrual blood loss anemia caused by profound hypothyroidism. The disturbance of hypothalamus-pituitary-ovarian axis due to the severe hypothyroidism is likely the major etiology for the excessive dysfunctional uterine bleeding.




J Med Cases. 2016;7(6):234-238
doi: http://dx.doi.org/10.14740/jmc2502w