Abstract
Background: Polycystic ovary syndrome (PCOS) and subclinical hypothyroidism (SCH) often coexist, but implications of the co-occurrence of two disorders have not yet been established. The objective is to conclude whether SCH with present or absent anti-thyroid antibodies (ATA) impacts on the PCOS phenotype and alters biochemical or clinical parameters. Methods: A retrospective cohort study was conducted in a tertiary reference center. Clinical and biochemical parameters of women with PCOS were analyzed. Results: A total of 367 women with PCOS were included in the study, 114 (31.1%) of whom were diagnosed with SCH and 16 (4.4%) with autoimmune thyroiditis (AIT). Among all parameters studied, the strongest relationship with SCH was confirmed for insulin resistance and dyslipidemia. SCH was an independent risk factor for insulin resistance. In SCH the additional presence of ATA did not exacerbate the metabolic disorders. There was no significant association of any PCOS phenotype with SCH, nor with the presence of circulating ATA. There was no significant difference in hormonal parameters and mFerriman–Gallwey scale score between women with PCOS with and without SCH. Conclusions: SCH alters metabolic, but not hormonal, parameters in PCOS. The diagnosis of SCH does not exclude the diagnosis of PCOS. The potential effect of positive ATA was insignificant.
Highlights
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies and affects 3 to 15% of women of reproductive age, depending on the studied population and the diagnostic criteria used [1,2]
The following parameters were analyzed for comparative analysis in the above-mentioned subgroups: (i) clinical parameters: menstrual cycle length, endometrial thickness, ovarian morphology, modified Ferriman–Gallwey scale score [31]; (ii) hormonal parameters: free thyroxine, free triiodothyronine luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio; estradiol, free androgen index (FAI), testosterone, sex hormonebinding globulin (SHBG), prolactin, vitamin D; (iii) metabolic parameters: homeostasis model assessment for insulin resistance (HOMA-IR), 2 h 75 g oral glucose tolerance test results [32] (75 OGTT; glucose at 0, 60, 120 min, insulin at 0, 60, 120 min), triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL)
subclinical hypothyroidism (SCH) was confirmed in 114 women (n = 114/367; 31.1%), the presence of circulating anti-thyroid antibodies (ATA) in 44 women (n = 44/367; 12.0%) and autoimmune thyroiditis (AIT) in 16 (n = 16/367; 4.4%)
Summary
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies and affects 3 to 15% of women of reproductive age, depending on the studied population and the diagnostic criteria used [1,2]. The most widely accepted diagnostic criteria of PCOS, i.e., the Rotterdam criteria [3], require the presence of two of the three following clinical symptoms: (i) hyperandrogenism/ hyperandrogenemia, (ii) ovulation disorders, i.e., oligoovulation or anovulation, or (iii) polycystic ovaries on ultrasound examination, while excluding other conditions that may cause hyperandrogenism or ovulation dysfunction. Studies conducted in recent years suggest a higher incidence of thyroid diseases, including subclinical hypothyroidism (SCH) [12,13] and autoimmune thyroiditis (AIT) [14] in women with PCOS, pointing out possible common etiology [15,16]. AIT, called Hashimoto thyroiditis (HT), affecting 5–20% of women of childbearing age, is one of the most common causes of hypothyroidism in areas with sufficient iodine content
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