Impact of subclinical hypothyroidism on infertility and other metabolic parameters in women with polycystic ovarian syndrome in South Asia

Authors

  • Israt Azmi Rolin Autism Support Worker, Mental Health Care, United Kingdom

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20233647

Keywords:

PCOS, SCH, Infertility, Metabolic parameters, South Asia

Abstract

Polycystic ovary syndrome (PCOS), is a very common endocrine and metabolic disorder in premenopausal women that affects 1 in 10 women of childbearing age. According to recent studies, the prevalence of PCOS was found around 53%. Many studies showed that subclinical hypothyroidism (SCH) and PCOS share symptoms which can influence PCOS symptoms like infertility and hormonal changes. This systematic review aimed to evaluate the impact of SCH on infertility and other metabolic parameters in women with polycystic ovarian syndrome in South Asia. For this review work, after a literature search through PubMed, Cochrane, and Google Scholar, 5 relevant papers were identified for this systematic review. The publication time was limited to the most recent 10 years, from 2011 to 2022. This review considered quantitative research on PCOS and SCH and used evidence-based data to support the findings. Among the mentioned 5 studies, 3 were cross-sectional and 2 were case-control. The studies were conducted on 2 groups: the SCH-PCOS intervention group and the PCOS control group. For the quality assessment, Cochrane's software, review manager (RevMan) was used to eliminate duplicate studies and reduce bias. The systematic review was conducted on 1468 female patients and measured anthropometric parameters in both groups. Total cholesterol, body mass index (BMI), TSH, free testosterone levels, insulin resistance and menstrual irregularities were all higher in the SCH-PCOS group compared to the PCOS group, along with a p<0.001 for each of the parameters. Usually, SCH and PCOS share symptoms. In cholesterol, BMI, TSH, free testosterone levels, insulin resistance and menstrual irregularities there are significant correlations between SCH and PCOS. So, there are some potential impacts of SCH on infertility and other metabolic parameters in women with polycystic ovarian syndrome in South Asia.

References

Azziz R. PCOS: a diagnostic challenge. Reproductive Biomed. 2004;8(6):644-8.

Dewailly D. Diagnostic criteria for PCOS: is there a need for a rethink? Best Pract Res Clin Obstetr Gynaecol. 2016;37:5-11.

Escobar-Morreale HF. Polycystic ovary syndrome: definition, etiology, diagnosis and treatment. Nature Rev Endocrinol. 2018;14(5):270-84.

Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Rev. 2016;37(5):467-520.

Kudesia R, Illions EH, Lieman HJ. Elevated prevalence of polycystic ovary syndrome and cardiometabolic disease in South Asian infertility patients. J Immigrant Minority Heal. 2018;19(6):1338-42.

Shengir M, Krishnamurthy S, Ghali P, Deschenes M, Wong P, Chen T et al. Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome. World J Gastroenterol. 2020;26(44):7046.

Balen AH. Polycystic ovary syndrome (PCOS). Obstetr Gynaecolog. 2017;19(2):119-29.

Persson S, Elenis E, Turkmen S, Kramer M, Yong E, Sundström-Poromaa I. Fecundity among women with polycystic ovary syndrome (PCOS)-a population-based study. Human Reproduct. 2019;34(10):2052-60.

Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;3(3):Cd007506.

Yu Q, Wang JB. Subclinical hypothyroidism in PCOS: impact on presentation, insulin resistance, and cardiovascular risk. BioMed Res Int. 2016;2016:2067087.

Fatima M, Amjad S, Ali Sr HS, Ahmed T, Khan S, Raza M, Inam M. Correlation of subclinical hypothyroidism with polycystic ovary syndrome (PCOS). Cureus, 2020;12(5).

Trakakis E, Pergialiotis V, Hatziagelaki E, Panagopoulos P, Salloum I, Papantoniou N. Subclinical hypothyroidism does not influence the metabolic and hormonal profile of women with PCOS. Hormone Mol Biol Clin Investigation. 2017;31(3).

Nayak PK, Mitra S, Sahoo J, Mahapatra E, Agrawal S, Lone Z. Relationship of subclinical hypothyroidism and obesity in polycystic ovarian syndrome patients. J Family Med Primary Care. 2020;9(1):147.

Kamrul-Hasan A, Aalpona FTZ, Selim S. Impact of Subclinical Hypothyroidism on Reproductive and Metabolic Parameters in Polycystic Ovary Syndrome–A Cross-sectional Study from Bangladesh. European Endocrinol. 2020;16(2):156.

Dhanpal V, Dharmalingam M, Kalra P. Effect of metformin therapy on thyroid-stimulating hormone levels in women with polycystic ovarian syndrome. Thyroid Res Pract. 2021;18(1):6.

Gilbert EW, Tay CT, Hiam DS, Teede HJ, Moran LJ. Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews. Clin Endocrinol. 2018;89(6):683-99.

Glintborg D, Kolster ND, Ravn P, Andersen MS. Prospective Risk of Type 2 Diabetes in Normal Weight Women with Polycystic Ovary Syndrome. Biomedicines. 2022;10(6):1455.

Mustari M, Hasanat M, Hasan Q, Tuqan S, Emran MS, Aktar N et al. Association of altered thyroid function and prolactin level in polycystic ovarian syndrome. Bangladesh Medical J. 2016;45(1):1-5.

Kowalczyk K, Radosz P, Barański K, Pluta D, Kowalczyk D, Franik G et al. The influence of treated and untreated subclinical hypothyroidism on metabolic profile in women with polycystic ovary syndrome. Int J Endocrinol. 2021;2021:8427150.

Parveen F. Effect of Vitamin D Supplementation on Metabolic Syndrome in Women with Polycystic Ovary Syndrome. Sch Int J Obstet Gynec, 2021;4(8):310-15.

Naher S, Begum SR, Ali L, Hakim M. Association of Thyroid Stimulating Hormone with Insulin Resistance in Women with Polycystic Ovarian Syndrome. J Armed Forces Med College Bangl. 2015;11(1):69-73.

Ho CW, Chen HH, Hsieh MC, Chen CC, Hsu SP, Yip HT et al. Increased risk of polycystic ovary syndrome and Its comorbidities in women with autoimmune thyroid disease. Int J Environmental Res Publ Heal. 2020;17(7):2422.

Goyal D, Relia P, Sehra A, Khandelwal D, Dutta D, Jain D et al. Prevalence of hypothyroidism and thyroid autoimmunity in polycystic ovarian syndrome patients: A North Indian study. Thyroid Res Pract. 2019;16(2):55.

Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metabol. 2015;19(1):25.

Boyle JA. Ask PCOS: identifying the need to inform evidence-based app development for polycystic ovary syndrome. Seminars in reproductive medicine. Thieme Medical Publishers. 2018;36.

McCambridge J, Kypri K. Can simply answering research questions change behavior? Systematic review and meta-analyses of brief alcohol intervention trials. PLoS One. 2011;6(10):e23748.

Robinson KA, Saldanha IJ, Mckoy NA. Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol. 2011;64(12):1325-30.

Ono K. The oligomer hypothesis in α-synucleinopathy. Neurochemical Res. 2017;42(12):3362-71.

Pokhariyal G. Importance of moderating and intervening variables on the relationship between independent and dependent variables. Int J Statistics Appl Math. 2019;4(5):1-4.

Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):1-7.

Lima NJS. Towards using boolean operators on graphs to generate network topologies." 2015 SBMO/IEEE MTT-S International Microwave and Optoelectronics Conference (IMOC). IEEE, 2015.

Patterson PD, Higgins JS, Weiss PM, Lang E, Martin-Gill C. Systematic review methodology for the fatigue in emergency medical services project. Prehospital Emer Care. 2018;22(1):9-16.

McCormack GR, Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behavioral Nutrit Physical Activ. 2011;8(1):1-11.

Wells GA, Shea B, Higgins JP, Sterne J, Tugwell P, Reeves BC. Checklists of methodological issues for review authors to consider when including non‐randomized studies in systematic reviews. Res Synthesis Methods. 2013;4(1):63-77.

Assasi N, Schwartz L, Tarride JE, Campbell K, Goeree R. Methodological guidance documents for evaluation of ethical considerations in health technology assessment: a systematic review. Expert Rev Pharmacoeconom Outcomes Res. 2014;14(2):203-20.

Eades CE, Ferguson JS, O'Carroll RE. Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Public Health, 2021;11(1):1-13.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Rev. 2011;10(1):1-11.

Selçuk AA. A guide for systematic reviews: PRISMA. Turk Arch Otorhinolaryngol. 2019;57(1):57.

Kahale LA, Elkhoury R, El Mikati I, Pardo-Hernandez H, Khamis AM, Schünemann HJ et al. Tailored PRISMA 2020 flow diagrams for living systematic reviews: a methodological survey and a proposal. F1000Research. 2021;10.

Stovold E, Beecher D, Foxlee R, Noel-Storr A. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Systematic Rev. 2014;3(1):1-5.

Su N. Positivist qualitative methods. The sage handbook of qualitative business and management research methods. 2018;17-31.

Fitzgibbons M, Meert D. Are bibliographic management software search interfaces reliable? A comparison between search results obtained using database interfaces and the EndNote online search function. J Academic Librarianship. 2010;36(2):144-150.

Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Library Asso. 2018;106(4):420.

Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta‐analysis, and clinical practice guideline: a systematic review. J Evidence-Based Med. 2015;8(1):2-10.

Margulis AV, Pladevall M, Riera-Guardia N, Varas-Lorenzo C, Hazell L, Berkman ND et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa scale and the RTI item bank. Clin Epidemiol. 2014;6:359.

Hartling L, Milne A, Hamm MP, Vandermeer B, Ansari M, Tsertsvadze A et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol. 2013;66(9):982-93.

Moskalewicz A, Oremus M. No clear choice between the Newcastle–Ottawa Scale and Appraisal Tool for Cross-Sectional Studies to assess methodological quality in cross-sectional studies of health-related quality of life and breast cancer. J Clin Epidemiol. 2020;120:94-103.

Deepak RFP, Payal C, Kalpana FNU, Sameer L, Krishan L, Wajeeha S et al. Frequency of Subclinical Hypothyroidism in Women with Polycystic Ovary Syndrome. Cureus. 2011;10.7759/cureus.17722.

Sinha U, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK. Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital-based cross-sectional study from Eastern India. Indian J Endocrinol Metabol. 2013;17(2):304-9.

Ganie MA, Laway BA, Wani TA, Zargar MA, Nisar S, Ahamed F et al. Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome. Fertil Steril. 2011;95(6):2039-43.

Bedaiwy MA. Clinical, hormonal, and metabolic parameters in women with subclinical hypothyroidism and polycystic ovary syndrome: a cross-sectional study. J Women's Heal. 2018;27(5):659-64.

Montgomery P, Movsisyan A, Grant SP, Macdonald G, Rehfuess EA. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Global Heal. 2019;4(1):e000848.

Hultcrantz M, Rind D, Akl EA, Treweek S, Mustafa RA, Iorio A et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol. 2017;87:4-13.

Flannelly LT, Flannelly KJ, Jankowski KR. Independent, dependent, and other variables in healthcare and chaplaincy research. J Heal Care Chaplaincy. 2014;20(4):161-70.

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Published

2023-11-28

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Section

Systematic Reviews