Subclinical Hypothyroidism in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Ding, Xiaoyan; Yang, Lili; Wang, Jian; Tang, Rong; Chen, Qianqian; Pan, Jiexue; Yang, Haisong; Xia, Chen; Chen, Zimiao; Mu, Liangshan

doi:10.3389/fendo.2018.00700

Cited by 33 publications

(26 citation statements)

References 47 publications

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“…A recent meta-analysis suggested that women with PCOS became more prone to SCH [36]. We did find that SCH worsens glucose metabolism and lipid metabolism in PCOS women.…”

Section: Discussioncontrasting

confidence: 47%

The Impact of Subclinical Hypothyroidism on Patients with Polycystic Ovary Syndrome: A Meta-Analysis

et al. 2021

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The association between subclinical hypothyroidism (SCH) and polycystic ovary syndrome (PCOS) has been shown in many studies. These findings are still controversial, however. It is unclear whether the co-incidence of subclinical hypothyroidism and polycystic ovary syndrome will affect the severity of metabolism. Therefore, we performed this meta-analysis to investigate the association. A comprehensive search strategy was developed to obtain all relevant studies published in PubMed, EMBASE, Cochrane Library, and Chinese Academic Journal Full-text Database (CNKI) up to 31 December 2020. We adopted the standardized mean difference (SMD) with 95% confidence intervals (CI) for evaluation, and sensitivity analysis was performed. Publication bias was analyzed and represented by a funnel plot, and funnel plot symmetry was assessed with Egger’s test. Twenty-seven studies with 4821 participants (1300 PCOS patients with SCH, 3521 PCOS patients without SCH) were included in the present meta-analysis,among which 71.31% chinese patients out of the total. The results showed that PCOS patients with SCH had higher levels of HOMA-IR, TG, TC, LDL, FBG, FCP, PRL and lower levels of HDL, LH and T. It also recognized the limitation of the lack of a consistent definition of hypothyroidism in the 27 studies included. The results of this study indicated that SCH may aggravate lipid and glucose metabolism in patients with PCOS.

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“…A recent meta-analysis suggested that women with PCOS became more prone to SCH [36]. We did find that SCH worsens glucose metabolism and lipid metabolism in PCOS women.…”

Section: Discussioncontrasting

confidence: 47%

The Impact of Subclinical Hypothyroidism on Patients with Polycystic Ovary Syndrome: A Meta-Analysis

et al. 2021

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“…AITD has been observed in 18%–40% of women with PCOS [ 64 ]. Incidence of SHypo, goiters, and thyroid autoimmunity is higher among females with PCOS, and they have higher anti-TPO levels, larger thyroid volumes, and more hypoechogenic thyroids than those without [ 63 , 65 , 66 ]. In euthyroid patients with PCOS, higher TSH is associated with increased prevalence of hyperandrogenic phenotype [ 67 ].…”

Section: Metabolic Dysfunctionsmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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“…In women with PCOS, compared with those without the condition, higher TSH levels, anti-thyroid antibody positivity rate, and prevalence of thyroid disorders, particularly HT, have been demonstrated in three independent meta-analyses conducted to date ( 9 , 229 , 230 ). Based on six studies, the combined OR of SCH risk for women with PCOS (compared with healthy women) was 2.87 (95% confidence interval (CI), 1.82–9.92; p < 10 -6 ), assuming a TSH cut-off level of > 2.5 mIU/L, and 3.59 (95% CI, 2.25–5.73; p < 10 -6 ) when limiting TSH to ≥ 4 mIU/L ( 229 ). Similarly, two meta-analyses indicated a significant association between PCOS and the presence of AITD: one included six studies (OR = 4.81; 95% CI, 2.88–8.04; p < 10 -5 ) ( 9 ) and the other included 13 studies (OR = 3.27; 95% CI, 2.32–4.63; p < 10 -4 ) ( 230 ).…”

Section: Joint Prevalence Of Polycystic Ovary Syndrome and Autoimmunementioning

confidence: 99%

Genetic Susceptibility to Joint Occurrence of Polycystic Ovary Syndrome and Hashimoto’s Thyroiditis: How Far Is Our Understanding?

Żeber‐Lubecka

Hennig

2021

Front. Immunol.

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Polycystic ovary syndrome (PCOS) and Hashimoto’s thyroiditis (HT) are endocrine disorders that commonly occur among young women. A higher prevalence of HT in women with PCOS, relative to healthy individuals, is observed consistently. Combined occurrence of both diseases is associated with a higher risk of severe metabolic and reproductive complications. Genetic factors strongly impact the pathogenesis of both PCOS and HT and several susceptibility loci associated with a higher risk of both disorders have been identified. Furthermore, some candidate gene polymorphisms are thought to be functionally relevant; however, few genetic variants are proposed to be causally associated with the incidence of both disorders together.

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Subclinical Hypothyroidism in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Cited by 33 publications

References 47 publications

The Impact of Subclinical Hypothyroidism on Patients with Polycystic Ovary Syndrome: A Meta-Analysis

The Impact of Subclinical Hypothyroidism on Patients with Polycystic Ovary Syndrome: A Meta-Analysis

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Genetic Susceptibility to Joint Occurrence of Polycystic Ovary Syndrome and Hashimoto’s Thyroiditis: How Far Is Our Understanding?

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