International Journal of Clinical and Experimental Medical Sciences

2023; 9(3): 55 - 61
http://www.sciencepublishinggroup.com/j/ijcems
ISSN: 2469-8024 (Print); ISSN: 2469-8032 (Online)

THE RELATIONSHIP BETWEEN FREE THYROID HORMONES (FTH) AND

MENARCHE IN ADOLESCENT GIRLS IN OWERRI, IMO STATE, NIGERIA
1
Ohiri J. U. 2Achigbu K.I.
1
Chemical Pathology department, Federal University Teaching Hospital, Owerri, Imo state.
2
Paediatrics Department, Federal University Teaching Hospital, Owerri, Imo State
*Corresponding author: johnnyohiri@gmail.com

ABSTRACT
Background: Thyroid dysfunction, such as hypothyroidism or hyperthyroidism, can disrupt
the menstrual cycle and menarche among young females. The current study was carried out to
assess the association of free thyroid hormones and menarche among adolescent girls in
Southern, Nigeria.
Method: A total of 80 females aged 10 – 18 years old attending secondary school in Owerri
were selected for the study. Serum TSH, fT3 and fT4 levels were measured using Enzyme-
linked immunoassay methods (ELISA) using commercial ELISA kits.
Results: Among the study population, the mean fT4 level being 1.8 ±0.5 ng/dL, while the mean
fT3 was 1.3±0.2 pg/mL and the average TSH was found to be 2.1±1.0 mIU/L. There was a
negative correlation between age of menarche and fT4 (r = -0.1), while there was a negative
correlation between fT3 and age of menarche (r = -0.1) and there was a positive correlation
between TSH and age of menarche (r = 0.1). However, the correlation of the hormones and age
of menarche was not statistically significant (p>0.05) Persons with abnormal TSH levels were
1.1times (0.2 – 6.3) likely to have menarche at ≤11 years. It was also observed that persons
with abnormal fT3 levels were 1.2 times (0.4 – 3.3) likely to have menarche at ≤11 years old.
However, the associations between hormone levels and early onset menarche were not found
to be statistically significant.
Conclusion: The mean levels of fT4, fT3, and TSH were within normal range, and while there
were some negative and positive correlations observed between the hormone levels and age of
menarche, these associations were not statistically significant. Additionally, there was no
significant association found between abnormal TSH or fT3 levels and early onset of menarche.

Keywords: thyroid hormones, Adolescent, Puberty, Menarche, Age of Menarche

1 INTRODUCTION
The thyroid gland plays an important role in the regulation of the menstrual cycle. Thyroid
hormones, particularly triiodothyronine (T3) and thyroxine (T4), have been shown to be
involved in the maturation and function of the female reproductive system[1–3]. Studies have
found that thyroid dysfunction, such as hypothyroidism or hyperthyroidism, can disrupt the
menstrual cycle and delay menarche[1, 4–7]. Hypothyroidism, which is characterized by low
levels of thyroid hormones, has been associated with delayed menarche and menstrual
irregularities in adolescents[1, 4, 8]. On the other hand, hyperthyroidism, which is

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characterized by high levels of thyroid hormones, has been associated with early menarche and
shorter menstrual cycles[9–11]. In addition to the overall levels of thyroid hormones, free
thyroid hormones (FT3 and FT4) have also been found to be associated. Physical growth,
nervous system development, body metabolism, and energy expenditure are all critically
influenced by thyroid hormones (THs)[1, 4, 7]. Thyroid stimulating hormone (TSH) is
produced by the pituitary in response to thyrotropin-releasing hormone from the hypothalamus,
leading to the production of thyroxine (T4) by thyroid follicular cells. T4 can then be converted
to active triiodothyronine (T3) in extrathyroidal tissues. Circulating T4 controls the process of
T4 to T3 conversion via negative feedback loops of the hypothalamic-pituitary-thyroid (HPT)
axis[2, 6, 11]. Free triiodothyronine (FT3) and free thyroxine (FT4) are considered sensitive
markers for evaluating thyroid function. Parameters such as Jostel's TSH index (TSHI) and
thyroid feedback quantile-based index (TFQI) are often used to indicate pituitary thyrotropic
function and thyroid homeostasis structure[5, 5, 7]. Puberty is a significant period of physical
and psychological change from childhood to adulthood, during which the reproductive system
matures via activation of the hypothalamic-pituitary-gonadal (HPG) axis. There is evidence to
suggest that thyroid function may influence the onset of puberty, and THs fluctuate
substantially during this period[2, 7, 8, 12]. However, it remains unclear how much THs change
for individuals at specific puberty stages or with specific pubertal development patterns.
Thyroid diseases are more prevalent in females than males in adulthood, and there is evidence
of direct effects of estrogen on thyroid function and growth regulation, as well as potential
underlying mechanisms[9–11]. While there are inconsistent study results for gender variations
in TSH, FT3, and FT4 levels during puberty, some studies report age-related trends in these
markers during the pubertal development period, particularly in females[5, 7, 8]. The current
study was carried out to assess the association of free thyroid hormones and menarche among
adolescent girls in Southern, Nigeria.

2. METHODS
2.1 Study Population
The study population consisted of Eighty (80) girls aged 10 to 18 years old attending secondary
school in Owerri, Imo State, Southern Nigeria.
2.2 Specimen Collection and Analysis
Five millilitres of venous blood were aseptically drawn from each participants and placed in
an appropriately labelled specimen bottle. Serum TSH, fT3 and fT4 levels were measured using
Enzyme-linked immunoassay methods (ELISA) using commercial ELISA kits according to the
manufacturer’s instructions (Gamma Pro, Seyeong NDS Co., Seoul, Korea).
2.3 Data Collection
A structured PROFORMA data collection sheet was used to record free thyroid hormone
measurements of the participants. Demographic information and the age of menarche was also
obtained from the participants.
2.4 Data Analysis
The data collected was analysed using the SPSS v25 software at a 95% confidence interval and
a p-value less than 0.05 was considered statistically significant. Frequencies, percentages, mean
and standard deviation were used to summarize the data collected. The chi-square statistics was
used to assess the association of hormone levels and age of menarche among the study
participants.
2.5 Ethical Consideration
Ethical approval to carry out the study was obtained from the Research and Ethics Committee
of the State Ministry of Health and the Federal Medical center, Owerri, Imo state. A letter of
intent and informed consent form was used to obtain permission from the parents/guardians of
the students prior to their enrolment into the study.

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3 RESULTS

Table 1 shows the demographic characteristics of the study participants. The table showed that
72 (90.0%) were between 10 – 14 years old and 8 (10.0%) were between 15 and 18 years old.
The mean age of the participants was 13.2 ±1.3 years.
Table 1: Demographic and Anthropometric characteristics of Participants

Variables Frequency (n=80) Percent (%)

Age Groups
10 – 14 72 90.0
15 - 18 8 10.0
Mean (SD) 13.2 (1.3)

Figure 1 shows the distribution of the age of menarche among the participants, indicating that
31% (25/80) experienced menarche after 15 years old, while 69% (55/80) experienced
menarche below 15 years.

25, 31% ≤15 years

>15 years

55, 69%

Figure 1: Distribution of Age of Menarche

Table 2 shows the summary of the hormone levels assessed in the study participants, with the
mean fT4 level being 1.8 ±0.5 ng/dL, while the mean fT3 was 1.3±0.2 pg/mL and the average
TSH was found to be 2.1±1.0 mIU/L
Table 2: Summary of Thyroid hormones assessed.

Variable Mean Std. Deviation

FT4 (ng/dL) 1.8 0.5
FT3 (pg/mL) 1.3 0.2
TSH (mIU/L) 2.1 1.0

The correlation of the age of onset of menarche and the hormones assessed as shown in Table
3 indicate a negative correlation between age of menarche and fT4 (r = -0.1), while there was
a negative correlation between fT3 and age of menarche (r = -0.1) and there was a positive
57
 correlation between TSH and age of menarche (r = 0.1). However, the correlation of the
hormones and age of menarche was not statistically significant (p>0.05)
Table 3: Correlation of Age of Menarche and thyroid hormones

Age of Pearson's Correlation

menarche vs coefficient p-value
FT4 -0.1 0.512
TSH 0.1 0.324
FT3 -0.1 0.718

Table 4 shows the association of age of menarche and distribution of hormone levels. The table
shows that persons with abnormal TSH levels were 1.1times (0.2 – 6.3) likely to have menarche
at >15 years. It was also observed that persons with abnormal fT3 levels were 1.2 times (0.4 –
3.3) likely to have menarche at >15 years old. However, the associations between hormone
levels and early onset menarche were not found to be statistically significant.
Table 4: Association of Age of Menarche and Hormone distribution

Variables Age of menarche (years) Chi-square OR (95% C.I)

>15 n, (%) ≤15 n, (%) Total n, (%) (p-value)
TSH (mIU/L)
Abnormal 2(28.6) 5(71.4) 7(100.0) 0.26 (0.873) 1.1 (0.2 – 6.3)
Normal (0.4-4.0) 23(31.5) 50(68.5) 73(100.0)
fT4 (ng/dL)
Abnormal 12(34.3) 23(65.7) 35(100.0) 0.26 (0.605) 0.7 (0.3 – 2.0)
Normal (0.8 – 1.8) 13(28.9) 32(71.1) 45(100.0)
fT3 (pg/mL)
Abnormal 13(28.9) 32(71.1) 45(100.0) 0.26 (0.516) 1.2 (0.4 – 3.3)
Normal (2.3 – 4.2) 12(34.3) 23(65.7) 35(100.0)

4 DISCUSSION
The study findings that 69% of the sample population experienced menarche before the age of
15[4, 11, 13, 14] years old is consistent with the results of previous studies. The mean levels
of fT4, fT3, and TSH were also within the normal range, which is similar to what has been
reported in other studies. However, the correlations observed between hormone levels and age
of menarche were not found to be statistically significant, which contrasts with some previous
studies that have reported significant associations[4, 5, 7, 15]. The negative correlation
observed between age of menarche and fT4, as well as fT3, suggests that higher levels of these
hormones may be associated with earlier onset of menarche. The positive correlation between
TSH and age of menarche suggests that higher levels of TSH may be associated with later onset
of menarche. However, it is important to note that these correlations were weak, and not

58
statistically significant, meaning that the relationship between thyroid hormone levels and age
of menarche in this study population may not be strong or consistent.
Comparing these findings to relevant studies, some previous research has reported significant
associations between thyroid hormone levels and age of menarche[7, 9, 13, 16], while others
have not. For example, a similar study by Vaitkus et al., found that higher levels of fT4 were
associated with earlier onset of menarche, while higher levels of TSH were associated with
later onset[6]. However, another study by Chen et al., found no significant association between
thyroid hormone levels and age of menarche[17]. The implications of these findings suggest
that while there may be some relationship between thyroid hormone levels and age of
menarche, the association is not strong enough to draw definitive conclusions. It is possible
that other factors, such as genetics or nutrition, may play a more significant role in the timing
of menarche[5, 15, 18, 19]. Further research with larger sample sizes and more diverse
populations is needed to better understand the complex factors that influence the onset of
menarche.
The results of the current study indicate that individuals with abnormal TSH levels were 1.1
times more likely to have menarche at or after 15 years of age compared to those with normal
TSH levels[4, 14, 20]. Similarly, individuals with abnormal fT3 levels were 1.2 times more
likely to have menarche at or after 15 years of age compared to those with normal fT3 levels.
However, it's important to note that these associations were not found to be statistically
significant, which means that it's possible that they could have occurred by chance. It's worth
noting that this study appears to be focused on delayed onset of menarche rather than early
onset, as the association between hormone levels and delayed onset menarche was not found
to be statistically significant[17, 21–23]. This could be due to the fact that the study had a
relatively small sample size or that other factors, such as genetics or environmental factors,
have a greater impact on the timing of menarche[1, 5, 16, 19]. Overall, while these findings
suggest a potential link between abnormal thyroid hormone levels and delayed onset of
menarche, more research would be needed to confirm this association and determine the
underlying mechanisms. Thyroid hormones play an important role in the regulation of the
reproductive system, and alterations in thyroid hormone levels can disrupt the normal hormonal
balance in the body, leading to changes in the timing of menarche[15, 16, 20, 22]. The findings
of this study suggest that monitoring thyroid hormone levels may be important in identifying
individuals at risk for early onset menarche and may help to inform preventative strategies.
However, it is important to note that the associations observed in this study were not
statistically significant, which may be due to the small sample size or other confounding factors
that were not accounted for in the analysis. Therefore, further research is needed to confirm
these findings and to determine the underlying mechanisms that may be responsible for the
observed associations.
5 CONCLUSION
Based on the findings presented, it can be concluded that the majority of the sample population
experienced menarche before the age of 11 years old. The mean levels of fT4, fT3, and TSH
were within normal range, and while there were some negative and positive correlations
observed between the hormone levels and age of menarche, these associations were not
statistically significant. Additionally, there was no significant association found between
abnormal TSH or fT3 levels and early onset of menarche. It is important to note that further
studies with larger sample sizes may be necessary to better understand the relationship between
hormone levels and age of menarche.

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