Impact of elevated thyroid-stimulating hormone levels in polycystic ovary syndrome

Abstract

The objective of this study was to analyse the impact of elevated thyroid-stimulating hormone (TSH) levels on the metabolic and endocrine phenotype in 583 women with polycystic ovary syndrome (PCOS). Endocrine and metabolic parameters were measured in all patients and compared between women with and without elevated TSH levels. Of the 583 women with PCOS, 125 women (21.4%) had thyroid disturbances (thyroid replacement therapy: 109 women, subclinical hypothyroidism: 16 women). Patients with elevated TSH levels had significantly increased fasting insulin, area under the curve–insulin, homeostatic model assessment–insulin resistance, and total cholesterol (TC)/high-density lipoprotein cholesterol (HDL) ratio and lower free thyroxin, insulin sensitivity and HDL (p < 0.05 for all). Euthyroid PCOS women with thyroid hormone substitution showed significant differences in TSH, age, body mass index, HDL and systolic blood pressure compared to those without hormone replacement therapy (p < 0.05 for all). We conclude that hypothyroid disturbances and elevated TSH levels are common findings in PCOS, which are associated with an adverse metabolic profile. Therefore, women with diagnosed PCOS should be screened for thyroid dysfunction.

Chinese abstract

本研究的目的在于分析促甲状腺激素（TSH）水平的升高对583名多囊卵巢综合征（PCOS）患者代谢与内分泌的影响。研究测定了所有患者的内分泌与代谢参数，并在TSH升高组与非TSH升高组间进行比较。在583名PCOS患者中，125名（21.4%）有甲状腺功能异常（甲状腺激素替代治疗：109名，亚临床甲状腺功能减退：16名）。TSH水平升高组患者的空腹胰岛素、曲线下胰岛素、稳态模型评估胰岛素抵抗、总胆固醇（TC）/高密度胆固醇（HDL）比率显著高于非TSH升高组，游离甲状腺素、胰岛素敏感性及HDL较低（所有p ＜0.05）。接受甲状腺激素替代治疗的甲状腺功能正常的PCOS患者与未接受治疗的患者相比，TSH、年龄、体质量指数（BMI）、HDL及收缩压均有显著差异（所有p ＜0.05）。研究显示，甲状腺功能减退与TSH水平升高在PCOS患者中十分普遍，且与不良代谢改变相关。因此，确诊PCOS的女性应检查甲状腺功能。

• Insulin resistance
• polycystic ovary syndrome
• subclinical hypothyroidism
• thyroid hormone replacement

Declaration of interest

The authors report no conflicts of interest. This work was supported by BioPersMed (COMET K-project 825329) which is funded by the Federal Ministry of Transport, Innovation and Technology (BMVIT) and the Federal Ministry of Economics and Labour/the Federal Ministry of Economy, Family and Youth (BMWA/BMWFJ) and the Styrian Business Promotion Agency (SFG). The study sponsors had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the article, and in the decision to submit the article for publication.