Ovarian Reserve and Serum Concentration of Thyroid Peroxidase Antibodies in Euthyroid Women With Different Polycystic Ovary Syndrome Phenotypes

Abstract

Objective: It has been shown that women with polycystic ovary syndrome (PCOS), as well as Hashimoto's thyroiditis (HT), are characterized by increased incidence of infertility. Serum anti-Müllerian hormone (AMH), which reflects ovarian reserve, is elevated in PCOS women and is decreased in women with HT. The Rotterdam criteria recognize four clinical PCOS phenotypes, i.e., phenotypes A, B, C, and D. The aim of the present study was to investigate the relation between serum concentrations of thyroid peroxidase antibodies (TPOAbs) and ovarian reserve in different PCOS phenotypes. Patients and methods: We examined 141 women with PCOS [phenotype A was diagnosed in 67 (47.5%) women, phenotype B in 30 (21.3%), phenotype C in 28 (19.9%), and phenotype D in 16 (11.3%)] and 88 control subjects of similar age; all women were euthyroid. Serum concentrations of AMH, thyroid-stimulating hormone (TSH), thyroid hormones, and TPOAbs were assessed. Results: We observed positive serum TPOAbs in 21.9% women with PCOS and in 23.9% controls (p = 0.07). We did not find differences in the frequency of detection of positive serum TPOAbs between phenotypes A, B, and C and the control group (p > 0.05). We did not observe a difference in AMH levels between TPOAbs-positive and TPOAbs-negative women, both in the control group and the PCOS women (all p > 0.05). However, serum AMH concentration was markedly higher in the whole PCOS group (p < 0.01) and in phenotype A (p < 0.01) vs. controls when the serum concentration of TPOAbs was negative. In the groups with positive serum levels of TPOAbs, serum concentration of AMH did not differ between PCOS phenotypes and controls (p = 0.23). Additionally, we observed that serum AMH concentration was related to the level of TPOAbs in the PCOS group (r = −0.4, p = 0.02). Conclusions: The frequency of serum detection of positive TPOAbs did not differ between PCOS phenotypes with clinical/biochemical hyperandrogenism and the control Adamska et al. AMH and TPOAbs in PCOS Phenotypes group. The observation of the difference in serum AMH between the PCOS and control groups only in TPOAbs negative women together with the inverse relation of TPOAbs with serum AMH only in the PCOS group might suggest that ovarian reserve is influenced by TPOAbs in PCOS.

Thyroid diseases and fertility disorders — Guidelines of the Polish Society of Endocrinology [Choroby tarczycy a zaburzenia płodności — rekomendacje Polskiego Towarzystwa Endokrynologicznego]

“…Another predisposing factor is the high oestrogen/progesterone ratio found in women with PCOS, increasing the risk of autoimmune diseases, and vitamin D deficiency [63]. A recently published study carried out by Polish authors did not confirm the association between PCOS and its different phenotypes and positive aTPO, but the results may have been influenced by the frequent occurrence of elevated aTPO concentrations in the control group (23.9% vs. 21.9% women with PCOS, p = 0.07) [64].…”

“…Adamska i wsp. stwierdzili, że stężenie aTPO ujemnie korelowało ze stężeniem AMH u kobiet z PCOS (r = -0,4; p = 0,02) [64]. Z kolei w dwóch badaniach autorów belgijskich i japońskich w grupach odpowiednio 5000 i 153 kobiet z niepłodnością nie stwierdzono związku pomiędzy podwyższonym stężeniem aTPO a NRJ [29,67].…”

“…Innym czynnikiem predysponującym jest wysoki stosunek estrogenów do progesteronu występujący u kobiet z PCOS, zwiększający ryzyko chorób autoimmunizacyjnych, oraz niedobór witaminy D [63]. Wyniki opublikowanego niedawno badania polskich autorów nie potwierdziły związku pomiędzy PCOS i jego różnymi fenotypami a dodatnimi aTPO, ale być może wpłynęły na nie częste występowanie podwyższonego stężenia aTPO w grupie kontrolnej (23,9% vs. 21,9% kobiet z PCOS, p = 0,07) [64].…”

Metabolic and Molecular Mechanisms of Diet and Physical Exercise in the Management of Polycystic Ovarian Syndrome

“…The frequent association with thyroid autoimmune diseases suggests that the autoimmunity could be at the basis of the disease [ 95 ]. In this regard, in women suffering from both PCOS and Hashimoto’s thyroiditis, levels of anti-Mullerian hormone (AMH) are negatively correlated with antithyroid peroxidase antibody (anti-TPO) levels, suggesting a decreased ovarian reserve in patients presenting these autoantibodies [ 96 , 97 ].…”

Association of Subclinical Hypothyroidism with Present and Absent Anti-Thyroid Antibodies with PCOS Phenotypes and Metabolic Profile

“…The coexistence of AIT with PCOS may be associated with an even greater risk of metabolic syndrome and infertility [ 22 , 23 ]. Complications pertain not only to overt hypothyroidism, but also SCH [ 24 , 25 ] and the presence of circulating anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies [ 26 ]. However, not all research results are consistent in this respect.…”