Abstract
The aim of the study was to investigate the possible overexpression of estrogen (ERs) and progesterone (PRs) receptors both in EPs glandular and stromal cells in postmenopausal women with levothyroxine-treated hypothyroidism in comparison to EPs detected in women with physiological thyroid hormone levels. During the study period (January-February 2013) 22 patients were eligible (12 treated, 10 controls). The two groups were homogenous for general, EPs sonographic and hysteroscopic features. None of the cases of atypia was found. Immunohistochemistry showed that the two groups were similar for ERs and PRs intensity rates in EPs glandular cells despite a trend of ERs percentage expression more than 60% in 2/3 of treated patients versus 1/3 of controls. In stromal EPs components, ERs intensity was high positive in 10 (83,3%) treated cases while it was high positive in 1 control (10%). Percentage of ERs stromal expression showed a different trend between the two groups despite a borderline statistical significance. Our hypothesis is based on a possible double action of hypothyroidism and thyroxine intake: the subclinical TSH increased levels and its possible circadian oscillation could stimulate the endometrial TSHRs (increasing type 2 DIO activity); the circulating levels of exogenous thyroxine could be locally metabolized in active form by type 2 DIO stimulating ERs.
Highlights
The aim of the study was to investigate the possible overexpression of estrogen (ERs) and progesterone (PRs) receptors both in glandular and stromal cells of Endometrial polyps (EPs) in postmenopausal women with levothyroxine-treated hypothyroidism in comparison to EPs detected in women with normal physiological thyroid hormone levels
Aghajanova et al demonstrated that thyroid hormones (THs) could be synthesized by both endometrial stromal cell and Ishikawa cell cultures after TSH stimulation [12]. This evidence suggested the hypothesis that endometrial stromal cells have TSHRs capable of binding thyrotropin, initiating secretion of THs independently from the hypothalamo-pituitarythyroid system. This concept was hypothesized by Catalano et al who demonstrated that progesterone molecular pathways are implicated in endometrial THs metabolism and signalling such as type II DIO, thyroid peroxidase (TPO), and thyroglobulin (TG)
Since our initial hypothesis was confirmed, we will start a perspective large cohort study in order to detect detailed different hormonal pathways in EPs pathogenesis between postmenopausal women levothyroxine-treated affected by hypothyroidism and controls
Summary
Endometrial polyps (EPs) are one of the most common gynecological conditions often diagnosed incidentally or associated with clinical symptoms such as infertility in reproductive age and abnormal vaginal bleeding both in premenopausal and postmenopausal women [1].The real incidence of EPs is unknown since endometrial polyps can occur in symptom-free women; the reported prevalence varies widely and ranges from 7.8% to 34.9%, depending on the definition of a polyp, diagnostic method used, and the population studied [2, 3].The prevalence of EPs appears to increase with age, and it is reported that more postmenopausal (11.8%) than premenopausal women (5.8%) are affected [1].The most frequent treatment of EPs is hysteroscopic removal of the lesions that could be performed both with anaesthesia in day-surgical setting and with office approach without anaesthesia [4].Many authors have conducted studies on risk factors for EPs onset both, in pre- and postmenopause. The real incidence of EPs is unknown since endometrial polyps can occur in symptom-free women; the reported prevalence varies widely and ranges from 7.8% to 34.9%, depending on the definition of a polyp, diagnostic method used, and the population studied [2, 3]. The prevalence of EPs appears to increase with age, and it is reported that more postmenopausal (11.8%) than premenopausal women (5.8%) are affected [1]. Many authors have conducted studies on risk factors for EPs onset both, in pre- and postmenopause. In most of these studies age and unopposed estrogen stimulation resulted in independent risk factors for EPs development [5,6,7]
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