Alieksieieva O. Optimization of treatment of abnormal uterine bleeding in patients with thyroid pathology

The dissertation focuses on the solution of the acute issue of obstetrics and gynecology, namely, clarifying the clinical and pathogenetic aspects of the occurrence of abnormal uterine bleeding in patients with thyroid pathology in order to optimize treatment plans and to reduce the risk of recurrence. To achieve the goal and solve the defined tasks, the research was conducted in three stages. At the first stage, after receiving the results of clinical and laboratory examination, patients with abnormal uterine bleeding were divided into two clinical groups (main and comparison) depending on the degree of thyroid pathology. The first (main) group consisted of 60 women with abnormal uterine bleeding (AUB) and thyroid pathology, the second group (comparison) included 30 patients with AUB. All 90 women underwent surgical intervention in the scope of hysteroresectoscopy due to AUB in the operating room of the surgical gynecology department with minimally invasive technologies of the Municipal Non-Commercial Enterprise of Kharkiv Regional Council “Regional Clinical Hospital”. The following research methods were used in the work: clinical, biochemical, immunoenzymatic, ultrasound, dopplerometry, hysteroscopic, cytometric, morphological and statistical. Decrease in the indices of vascular resistance in the radial and basal arteries indicated a lowering the blood flow resistance in the endo- and myometrial areas and the presence of pronounced venous stasis in almost half of the observed patients, which requires a differentiated approach to the selection of treatment tactics aimed at improving blood flow and reducing venous blood filling in the small pelvis. The research added scientific data on the clinical and pathogenetic features of AUB development in women with thyroid pathology. The information about the state of the endometrium depending on the nature of uterine blood flow, hormonal indicators, and the presence of eryptosis in patients with AUB was also received. The role of Doppler velocimetry indices (especially the state of the arcuate, radial and basal vessels of the endometrium) in diagnosing AUB and the effectiveness of treatment plans was clarified. For the first time, the role of eryptosis in AUB development in patients with AIT was determined. The study proved the activation of eryptosis processes due to the development of oxidative stress in erythrocytes, changes in the physicochemical properties of the phospholipid bilayer of cell membranes in erythrocytes, which led to their apoptosis. To reduce AUB recurrences in patients with AIT, a comprehensive treatment method was proposed, and an algorithm for patients’ examination and management was developed. The obtained data expanded knowledge about AUB pathogenesis in women with thyroid pathology and substantiated the feasibility of improving the methods of treatment and rehabilitation to prevent disease relapses. The practical significance of the obtained results lies in theoretical substantiation and solution of the acute scientific problem of reducing AUB recurrence by clarifying the clinical and pathogenetic aspects of the development of abnormal uterine bleeding in women with thyroid pathology and optimizing their treatment plans. Deficiency of thyroid hormones contributes to an imbalance of the gonadotropic function of the pituitary gland with a subsequent decrease in steroidogenesis and the development of functional hyperprolactinemia and abnormal uterine bleeding. Abnormal uterine bleeding in combination with hypothyroidism is associated with the activation of eryptosis, the development of oxidative stress in erythrocytes and changes in the physicochemical properties of the phospholipid bilayer of cell membranes in erythrocytes. The conducted research helped to improve the criteria for AUB diagnosis in women with AIT taking into account the hormonal status and factors of eryptosis. An objective assessment of the state of the endometrium using ultrasound and Doppler velocimetry monitoring was proposed. The optimal pathogenetically justified method of AUB treatment in women with AIT was selected to reduce possible relapses and the frequency of surgical intervention. Improvements in the algorithm of diagnostic and therapeutic activities in women with AUB and AIT were aimed at eliminating recurrences of the disease by timely identification of endometrial disorders, eryptosis processes and timely hysteroresectoscopy followed by the appointment of treatment in order to reduce AUB relapses in women with AIT.