Hypothyroidism is prevalent among adult women with chronic lower urinary tract symptoms (LUTS)

[helvella]

A very recent paper with a potentially important indicator of hypothyroidism.

My conclusion is that chronic LUTS should automatically be given a full thyroid panel (unless already diagnosed hypothyroid). One third is a very large proportion.

Also, need to consider the current treatment of those who have already been diagnosed.

Hypothyroidism is prevalent among adult women with chronic lower urinary tract symptoms

Mahtab Zargham, Mohammad Reza Hajian, Farshid Alizadeh, Mohammad-Javad Eslami, Noushin Khalili Boroujeni, Farshad Gholipour

First published: 27 February 2022

doi.org/10.1111/luts.12428

Funding information: Isfahan University of Medical Sciences

Abstract

Objective

To define the prevalence of hypothyroidism in women with chronic lower urinary tract symptoms (LUTS) and to compare the severity of each symptom between patients with hypothyroidism and controls.

Subjects and methods

In this prospective observational study, we screened all adult women who came to the urology clinic between March 2017 and September 2020, and enrolled patients with chronic LUTS in the study. We assessed thyroid function. We evaluated the severity of voiding and storage urinary symptoms by the International Prostate Symptom Score. We also assessed the severity of urge urinary incontinence (UUI) and stress urinary incontinence (SUI). For between-group analysis, we selected age-matched cases and controls and compared them regarding the distribution and severity of urinary symptoms.

Results

Seven hundred and twenty-five women with a mean age of 51.7 ± 14.0 years were included in the final analysis. Two hundred fifty-eight patients (35.6%) had hypothyroidism. Age-matched case and control groups consisting of 210 patients each were selected. There was no significant difference in the severity and distribution of voiding LUTS and UUI between the study groups (P values >0.05). The severity of storage symptoms was lower in patients with hypothyroidism (P =0.04). Sixty-seven patients with hypothyroidism (31.9%) had SUI, which was significantly higher than controls (23.3%) (P =0.03).

Conclusion

More than one-third of women with chronic LUTS have hypothyroidism which is much more frequent than in the general population. We also suggest a possible relationship between hypothyroidism and the severity of SUI and an inverse relationship between hypothyroidism and storage symptoms.

Full paper is behind a paywall:

onlinelibrary.wiley.com/doi...

[nellie237]

A reminder to keep up with the pelvic floor exercises then.

[stiltzski]

That’s very interesting. I was diagnosed with an unstable bladder years before anyone looked at my thyroid function & even then I was told I had ‘only borderline’ hypothyroidism & was not given treatment. I had to wait more years until Dr Skinner gave me that.

[tattybogle]

...... So were these 258 ladies previously undiagnosed hypo and therefore untreated ? .. hard to say without seeing the full text .. but if that's the case then TFT's should certainly become 'routine' for patient complaining of chronic urinary tract symptoms . My bladders behaviour is definitely very closely connected to my level of Thyroid Hormone.

Personally i'm starting to think it would be much shorter to compile a list of presenting symptoms where a 'routine' TFT should NOT be done.

Broken leg ?.

Splinter in big toe ?

hiccups ?

[helvella Administrator in reply to tattybogle]

Broken leg more likely if concentration impaired, slowed reactions and muscles not working quite right.

Splinter more likely in someone as above.

I suggest clumsiness is definitely a symptom of hypothyroidism - which could also be a factor.

[tattybogle in reply to helvella]

actually i agree . last time i got a splinter in the sole of my foot (that turned into a chronic deep corn that took ages to sort out with a private chiropodist, and in the meantime resulted in me walking funny for months and knackering my knee joint again !) .. it was because i had had my Levo dose reduced by too much~ so i was dragging my bare feet round the shonky floorboards because it was too much effort to go up 2 flights of stairs and find my F* ing slippers

So that just leaves 'hiccups' then.. but i bet if we try hard we can find a thyroid hormone cause for them too.

[helvella Administrator in reply to tattybogle]

Some members want everything.

Obviously a very rare diagnosis.

Neuromyelitis optica (NMO) and autoimmune thyroiditis

Sreenivasa Rao Sudulagunta 1 , Mahesh Babu Sodalagunta 2 , Hadi Khorram 3 , Mona Sepehrar 4 , Mohammed Aheta Sham 5 , Ranjitha Nidsale Sudarshan 6 , Rekha Gangadharappa 6

Affiliations

• PMID: 26568836

• PMCID: PMC4626629

• DOI: 10.1093/omcr/omv054

Free PMC article

Abstract

Neuromyelitis optica (NMO or Devic's syndrome) is a rare demyelinating disease of the CNS that predominantly affects the spinal cord and optic nerves and shares many clinical and radiological features with multiple sclerosis (MS). The association of NMO with autoimmune thyroiditis has been reported very rarely. Early differentiation between NMO and MS is very important because they have different natural courses and treatment regimens. We report a case regarding a 53-year-old woman who was admitted initially with hiccups and paraesthesias, but was not evaluated during first two episodes and presented with severe progression of NMO. Patient was found to have autoimmune thyroiditis with lymphocytic infiltration of thyroid which progressed to hypothyroidism. NMO was diagnosed with seropositivity for NMO-IgG and longitudinally extensive spinal cord lesions (three or more spinal segments). Patient poorly responded to treatment due to the lack of early diagnosis and aggressive immunosuppressant therapy.

pubmed.ncbi.nlm.nih.gov/265...

[tattybogle in reply to helvella]

Very efficient .. thankyou x

[asiatic in reply to tattybogle]

Hiccups as a Rare Presentation of Thyrotoxicosis Triaged by an Epidural Steroid Injection

cureus.com/articles/62112-h...

[ Added a note of what to expect if people click on the link. ]

[tattybogle in reply to asiatic]

Well well, who knew?.... we have a " neuroanatomical hiccup center "

actually i once had hiccups for 4 days non stop at Secondary School .... it's not funny at all .. it becomes extremely painful after a while...

it was exam time so i put it down to stress at the time . I can't remember what stopped them now ... but i do remember 4 days of kids and teachers jumping out from behind every corner to make me jump and trying to drink upside down.. in fact trying everything known to man ...... Apparently it's quite difficult to teach maths with kid at the back hiccuping loudly every few seconds while the rest of the class take the piss.

[helvella Administrator in reply to tattybogle]

Four days is bad. But there are almost unbelievable stories of people who have suffered for years and years.

[tattybogle in reply to helvella]

that's grimm... i was ready for someone to shoot me after 4 days .. and there were plenty of offers.

[Charlie-Farley in reply to tattybogle]

Tatty helvella

Do you remember that little girl in the 70’s who was a chronic hiccup’er - she was on Blue Peter at one stage I think 🤔

[helvella Administrator in reply to Charlie-Farley]

Afraid not. Doesn't ring any bells at all for me.

[RButus in reply to tattybogle]

I'm so interested in your reply - I stopped self-medicating NDT (long story) early in 2021 for fear of being found out before surgery and then figured I could get on okay-ish without (scared of bone loss)...then out of the blue, a UTI that hasn't really gone away, diagnosis of vaginal atrophy, and wretched bladder issues alongside! Well, well, well...and a friend today mentioned her own Levo/bladder experiences and here I find more mention! I'm retrying NDT (low dose) to restore some energy and - now - in hopes it might reverse the overactive bladder. I'd be interested to hear your Thyroid/bladder relationship, tattybogle, if you could bear it.

[tattybogle in reply to RButus]

I'll write it tomorrow my dinners nearly ready .

[RButus in reply to tattybogle]

Thanks, TB, enjoy your meal and have a nice evening

[tattybogle in reply to RButus]

Hi RButus. my bladder connection to thyroid seems to be with overmedication (on Levo) After the menopause i became over medicated on the 150mcg dose i had been stable on for over a decade.

The initial symptom i went to the GP about was bladder related. it felt rather like i had cystitis but without the characteristic burning pain on urinating... this had been going on for months , and was worsening .

My bladder was always tense and uncomfortable often painfully so ,and it just generally felt irritated , i was starting to wonder if i had 'Interstitial Cystitis' ... I was needing to urinate very frequently , just small amounts . and the bladder still didn't feel relaxed even after i'd been. i was getting frequent 'urge incontinence, and not managing to get to the bathroom in time. My daily activities became dominated by where the nearest bathroom was.

For several months i had also been dealing with a very painful ? kidney area /back pain. i constantly had a hot water bottle tucked into the back of my trousers at work. The pain was sometimes severe enough that friends (and later the GP) suggested ?kidney stones .

( i also had other more characteristic symptoms of overmedication , but i didn't recognise them as such at the time, and neither did the GP's.. and they didn't initially run a thyroid blood test.. but i was very 'jumpy' my startle reflex was 'through the roof' ,and i was uncharacteristically over anxious, and i was having 3/ 4 bowel movement every morning)

The first GP did a urine test , which showed no UTI, but showed microscopic blood in urine and also Calcium Oxalate crystals. So she suspected kidney stones and sent me for an ultrsound of kidney's / bladder .. which showed nothing abnormal and didn't see any kidney stones.

Then another GP started thinking about looking for a cancer, due to the weight loss i had seen, and the general state of 'feeling bloody awful', so they referred me for for a CT with contrast and an endoscopy and a colonoscopy .

However, the referral had taken longer than expected for a '2 week pathway' ,.... so i had contacted the GP's again to check up on the referral due to how very unwell i felt .. and this time i saw an older female GP... who actually looked at me and examined me properly (!) ... during this appointment she said .. "has anybody checked your thyroid bloods yet ? .. Mmmm .. no .. well that should have been done first... Hold your hands out in front of you (fine tremor in fingers was then seen ) .. i'll order thyroid bloods now , but i think you are probably overmedicated. "

A dose reduction from 150mcg to125mcg ensued the next day , and the bladder symptoms and ? kidney pain were both very much improved by the time i went for the CT scan the following week.. and were completely better by the time i saw the consultant to discus the normal CT /colonoscopy / endoscopy results.

That was a few yrs ago now (2016?), and i have had no return of the bladder issues or ?kidney /back pain .

I'm now on 112.5mcg usually , but last year i tried a few months of going back to 125mcg

just to see if it would shift an unwelcome spare tyre i was growing. and one of the reasons i stopped it and went back to 112.5mcg was the return of more frequent trips to the bathroom and noticing every trip out involved me saying , "hang on a minute , i just need to find a loo "

I suspect that it took many months of overmedication the first time, before the bladder issue got to be a significant problem.... but subtle signs of this returning is one of the clues i now look out for to help me monitor my thyroid hormone dose .

Here endeth the epistle on 'me and my bladder'

[RButus in reply to tattybogle]

Thanks so much TB, for your full and fine answer. It sounds like you've had a hell of a time, almost parallel with me but mine's not been as bad as yours. And mine is definitely not down to overmedication as I wasn't on NDT when this damned thing started, it's all been down to menopause and lack of oestrogen, allegedly (I'm not going down the cancer route, I've had 6 months' deep anxiety and depression at the thought. After my last frightfully painful smear test - blood and tears - gave me PTSD I couldn't contemplate cytoscopy, especially with the vulnerable state of the bits). Been hugely aided by a medical herbalist who advises Bladder Health UK so bladder doesn't feel irritated - until today - Candida has reared its vile head again, dammit. Why wasn't I told that menopause could get this ugly? Glad your bladder/kidney issues resolved, TB, one thing less to worry about

[Tythrop]

Snap

[Charlie-Farley]

Suffered with UTIs most of my adult life. Was taking antibiotics as required - a compromise I came to with my doc, rather than the one a day for the rest of my life he had suggested. Perhaps this new knowledge will save others…..haven’t had a UTI in a few years - I suspect hormones play a part and no longer need birth control, but D-mannose has been very useful and replaced the need for ABs. I also suspect taking ABs throughout my life, on and off has contributed/caused leaky gut and inflammation.

Things have improved for me dramatically. I’m on a therapeutic dose of Levothyroxine and I think because I realised I was being mismanaged and got on top of the situation quickly - (thanks to this forum providing useful advice and info). As of now, I’m on an even keel.

It is striking from reading lived experience, the longer it takes to get adequate treatment, the harder to get well………. Perhaps a thyroid panel when people are presenting with repeated UTIs could be a step in the right direction.

But, this one third of women being hypothyroid? Am I the only one who suspects the proportion will eventually be found to be much higher?

How many more are there who are not included in the hypothyroid group because they fall into that very grey area they (the medical profession) euphemistically call subclinical ?

Subclinical by very flawed diagnostics at the expense of actually looking at symptoms…… patient ping-pong.

[helvella Administrator in reply to Charlie-Farley]

The definition of hypothyroid needs a serious re-appraisal.

And, when the current definitions are used as in this paper, yes, it will under-count.

I think we just need to be careful not to invert it and push hypothyroidism as the only possible cause. Even if it ended up a significant majority.

[Charlie-Farley in reply to helvella]

Indeed, but I’m pretty sure it is an underestimation too. I when I was working through my dose increases, I had a hierarchy of symptoms that fell away in a definite order as my body prioritised various functions. Thankfully cognition came back first - though it ‘dipped and yarred’ like a boat navigating choppy seas.

The last symptom to leave me and I waved it a relieved farewell was the leaky bladder. It was also the definitive symptom indicator for me that I needed another dose increase at 100 to 125 and then finally to 150ug of levo.

Oh joy! ☺️