Thyroid disorders in polycystic ovary syndrome patients

• Elena E. Grodnitskaya

Abstract

Polycystic ovary syndrome (PCOS) and hypothyroidism are some of the most common endocrinopathies seen in females. Thyroid disorders, especially Hashimoto’s thyroiditis (HT), and polycystic ovary syndrome (PCOS) are closely associated, based on a number of studies showing a significantly higher prevalence of HT in women with PCOS than in controls. However, the mechanisms of this association are not as clear. Certainly, genetic susceptibility contributes an important part to the development of HT and PCOS. However, a common genetic background has not yet been established. Harmful metabolic and reproductive effects were shown to be more pronounced in women with HT and PCOS when compared with women with HT alone or with controls. Combination of this disorders may make diagnosis difficult. Clinicians need to focus onthe screening of the thyroid disordersin PCOS women even in the absence of there symptoms.

Keywords:polycystic ovary syndrome; thyroid; hypothyroidism; Hashimoto’s thyroiditis; women

References

1. Skiba M.A., Islam R.M., Bell R.J., Davis S.R. Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2018; 24 (6): 694–709.

2. Teede H.J., Tay C.T., Laven J.J.E., et al. International PCOS Network. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023; 189 (2): G43–64.

3. Hulchiy M., Zhang H., Cline J.M., et al. Receptors for thyrotropin-releasing hormones, thyroid-stimulating hormones, and thyroid hormones in the macaque uterus: effects of long-term sex hormones treatment. Menopause. 2012; 19: 1253–9.

4. Palomba S., Colombo C., Busnelli A., et al. Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature. Front Endocrinol (Lausanne). 2023; 14: 1251866.

5. Fan H., Ren Q., Sheng Z., et al. The role of the thyroid in polycystic ovary syndrome. Front Endocrinol (Lausanne). 2023; 14: 1242050.

6. Tresa A., Rema P., Suchetha S., et al. Hypothyroidism presenting as ovarian cysts – a case series. Indian J Surg Oncol. 2021; 12 (suppl 2): 343–7.

7. Fitko R., Kucharski J., Szlezyngier B. The importance of thyroid hormone in experimental ovarian cyst formation in gilts. Anim Reprod Sci. 1995; 39: 159–68.

8. Saei Ghare Naz M., Rostami Dovom M., Ramezani Tehrani F. The menstrual disturbances in endocrine disorders: a narrative review. Int J Endocrinol Metab. 2020; 18 (4): 106694.

9. Hollowell J.G., Staehling N.W., Flanders W.D., et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87: 489–99.

10. Artini P.G., Uccelli A., Papini F., et al. Infertility and pregnancy loss in euthyroid women with thyroid autoimmunity. Gynecol Endocrinol. 2013; 29 (1): 36–41.

11. Xie J., Jiang L., Sadhukhan A., et al. Effect of antithyroid antibodies on women with recurrent miscarriage: a meta-analysis. Am J Reprod Immunol. 2020; 83 (6): e13238.

12. Consortium on Thyroid and Pregnancy – Study Group on Preterm Birth. Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis. JAMA. 2019; 322 (7): 632–41.

13. Romitti M., Fabris V.C., Ziegelmann P.K., et al. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr Connect. 2018; 7 (11): 1158–67.

14. Mobeen H., Afzal N., Kashif M. Polycystic ovary syndrome may be an autoimmune disorder. Scientifica (Cairo). 2016; 2016: 4071735.

15. Petrikova J., Lazurova I., Dravecka I., et al. The prevalence of non organ specific and thyroid autoimmunity in patients with polycystic ovary syndrome. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015; 159: 302–6.

16. Gaberšček S., Zaletel K., Schwetz V., et al. Mechanisms in endocrinology: thyroid and polycystic ovary syndrome. Eur J Endocrinol. 2015; 172 (1): R 9–21.

17. Hatzirodos N., Bayne R.A., Irving-Rodgers H.F., et al. Linkage of regulators of TGF-β activity in the fetal ovary to polycystic ovary syndrome. FASEB J. 2011; 25 (7): 2256–65.

18. Akinci B., Comlekci A., Yener S., et al. Hashimoto’s thyroiditis, but not treatment of hypothyroidism, is associated with altered TGF-b1 levels. Arch Med Res. 2008; 39: 397–401.

19. Li Q., Yang G., Wang Y., et al. Common genetic variation in the 3’-untranslated region of gonadotropin-releasing hormone receptor regulates gene expression in cella and is associated with thyroid function, insulin secretion as well as insulin sensitivity in polycystic ovary syndrome patients. Hum Genet. 2011; 129: 553–61.

20. Zou S., Sang Q., Wang H., et al. Common genetic variation in CYP1B 1 is associated with concentrations of T4, FT3 and fT4 in the sera of polycystic ovary syndrome patients. Mol Biol Rep. 2013; 40: 3315–20.

21. Zeber-Lubecka N., Hennig E.E. Genetic susceptibility to joint occurrence of polycystic ovary syndrome and Hashimoto’s thyroiditis: how far is our understanding? Front Immunol. 2021; 12: 606–20.

22. Hu C., Pang B., Ma Z., Yi H. Immunophenotypic profiles in polycystic ovary syndrome. Mediators Inflamm. 2020; 2020: 5894768.

23. Fairweather D., Rose N.R. Women and autoimmune diseases. Emerg Infect Dis. 2004; 10: 2005–11.

24. Singla R., Gupta Y., Khemani M., Aggarwal S. Thyroid disorders and polycystic ovary syndrome: an emerging relationship. Indian J Endocrinol Metab. 2015; 19: 25–29.

25. Chapman J.C., Kunaporn S., Shah S. et al. The differential effect of injecting estradiol-17b, testosterone, and hydrocortisone during the immune adaptive period on the fertility of female mice. Am J Reprod Immunol. 2001; 46: 288–97.

26. Chapman J.C., Min S.H., Freeh S.M., Michael S.D. The estrogen-injected female mouse: new insight into the etiology of PCOS. Reprod Biol Endocrinol. 2009; 7: 47.

27. Singh J., Wong H., Ahluwalia N., et al. Metabolic, hormonal, immunologic, and genetic factors associated with the incidence of thyroid disorders in polycystic ovarian syndrome patients. Cureus. 2020; 12 (11): e11681.

28. Iwasa A., Arakaki R., Honma N., et al. Aromatase controls Sjögren syndrome-like lesions through monocyte chemotactic protein-1 in target organ and adipose tissue-associated macrophages. Am J Pathol. 2015; 185 (1): 151–61.

29. Muscogiuri G., Sorice G.P., Mezza T., et al. High-normal TSH values in obesity: is it insulin resistance or adipose tissue’s guilt? Obesity. 2013; 21: 101–6.

30. Kwiat V.R., Reis G., Valera I.C., Parvatiyar K., Parvatiyar M.S. Autoimmunity as a sequela to obesity and systemic inflammation. Front Physiol. 2022; 13: 887702.

31. Morgante G., Darino I., Spanò A., et al. PCOS physiopathology and vitamin d deficiency: biological insights and perspectives for treatment. J Clin Med. 2022; 11 (15): 4509.

32. ESHRE Guideline Group on RPL; Bender Atik R., Christiansen O.B., Elson J., et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023; 2023 (1): hoad002.

33. Tańska K., Gietka-Czernel M., Glinicki P., Kozakowski J. Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes. Front Endocrinol (Lausanne). 2023; 13: 1049665.

34. van den Boogaard E., Vissenberg R., Land J.A., et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2016; 22 (4): 532–3.

35. Poppe K., Bisschop P., Fugazzola L., et al. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction. Eur Thyroid J. 2021; 9 (6): 281–95.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)