The dissertation is devoted to increasing the effectiveness of diagnosis and treatment of autoimmune thyroid pathology in women of reproductive age, based on a comprehensive assessment of hormonal homeostasis indicators, ovarian reserve, metabolic parameters, markers of immune inflammation, vitamin D status, and timely forecasting of hormonal disorders in autoimmune thyroiditis with vitamin D deficiency that affect reproductive prognosis. Based on the results of a comprehensive examination of reproductive-aged women with autoimmune thyroiditis, the influence of autoimmune dysfunction of the thyroid gland on reproductive function was assessed for the first time, taking into account the results of anamnestic, clinical, and laboratory characteristics and establishing correlations between thyroid status, sex hormones, 25-hydroxyvitamin D (25(OH)D) levels, and metabolic changes associated with the disease. It was demonstrated that hypothyroidism of the thyroid gland leads to progressive elevation of gonadotropin hormones and decreased estradiol levels, which is a precondition for reducing the functional ovarian reserve; it is confirmed by decreased anti-Müllerian hormone concentration.
The levels of pro-inflammatory cytokines TNF-α, IL-6, IL-17, IL-23 were investigated in reproductive-aged women with autoimmune thyroiditis and different functional states of the thyroid gland for the first time. Correlations between cytokine levels, 25(OH)D level, and thyroid status were established.
The scientific work also included the evaluation of the psycho-emotional state of reproductive-aged women with autoimmune thyroiditis. The proposed treatment course for women of reproductive age with autoimmune thyroiditis includes the administration of levothyroxine medications at doses of 25-50 μg/day for subclinical hypothyroidism and 1.6 μg/kg/day for overt hypothyroidism, myoinositol at a dose of 2000 mg/day, 6000 IU of cholecalciferol for established deficiency and 4000 IU for diagnosed insufficiency of vitamin D, over a period of three months, with subsequent reduction of cholecalciferol dose to 2000 IU after achieving the target level of 25(OH)D in the blood of 30 ng/ml or higher, and selenium 200 μg/day. This treatment course provided an appropriate corrective effect on the altered parameters of metabolic, hormonal, and immune status. A predictive model for hormonal disorders leading to an unfavorable reproductive prognosis in women with autoimmune thyroiditis was developed, based on triggering factors and important laboratory data.
