DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20163008
Published: 2017-02-03

Hypothyroidism in polycystic ovarian syndrome: a comparative study of clinical characteristics, metabolic and hormonal parameters in euthyroid and hypothyroid polycystic ovarian syndrome women

Ramanand SJ, Raparti GT, Halasawadekar NR, Ramanand JB, Kumbhar AV, Shah RD

Abstract


Background: This study was conducted to examine influence of hypothyroidism on pathophysiology and features of PCOS with respect to clinical characteristics of polycystic ovarian syndrome (PCOS), hormonal and metabolic profile.

Methods: 102 euthyroid PCOS and 18 hypothyroid PCOS women were included in this cross-sectional study after considering inclusion and exclusion criteria. The study subjects were assessed for various signs and symptoms like recent weight gain, obesity, abnormal hair growth, hirsutism, hair loss, acne, acanthosis nigricans and infertility. Various hormonal and metabolic parameters were evaluated viz. Luteinizing hormone, Follicle stimulating hormone, LH:FSH ratio, testosterone, prolactin, dehydroepiandrosterone, fasting insulin and fasting blood glucose. BMI and HOMA values were calculated.

Results: Association of hirsutism, excessive hair growth, hair loss, acanthosis nigricans, acne, infertility was not significant between the two groups. Majority of patients in both the groups were overweight/obese. BMI and number of patients complaining weight gain was significantly more in hypothyroid PCOS women. While no statistical difference in LH, FSH, LH:FSH ratio, prolactin, and testosterone levels was found, serum DHEA level was significantly less in hypothyroid PCOS group. No statistical difference in fasting blood glucose and insulin levels was found between the two groups. Though both the groups show insulin resistance, HOMA values were significantly more in hypothyroid PCOS women.

Conclusions: Presence of hypothyroidism significantly increased severity of insulin resistance as well as obesity in PCOS. This could have adverse metabolic consequences in them. Concurrent occurrence of both these disorder could also possibly affect other features of the PCOS viz. hair loss and infertility.


Keywords


PCOS, Hypothyroidism, Obesity, BMI, HOMA, DHEA, Infertility

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References


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 Endocr Metab. 2013;17:304-9.

Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH, Ghanghas RR, Jain SS. Clinical characteristics of polycystic ovary syndrome in Indian women. Indian J Endocr Metab. 2013;17:138-45.

Rotterdam ESHRE/ASRM‑Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long‑term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19‑25.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163‑70.

Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181.

Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perrild H, Ovesen L, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab. 2005;90:4019-24.

Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol. 1988;19:831-6.

Church RE. Hypothyroid hair loss. Br J Dermatol. 1956;77:661-3.

Sterry W, Konrads A, Nase J. Alopecia in thyroid diseases: Characteristic trichograms. Hautarzt. 1980;31:308-14.

Ober KP. Acanthosis nigricans and insulin resistance associated with hypothyroidism. Arch Dermatol. 1985;121:229-31.

Pfeifer SM, Kives S. Polycystic ovary syndrome in the adolescent. Obstet Gynecol Clin North Am. 2009;36(1):129-52.

Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2:17-9.

Tagawa N, Tamanaka J, Fujinami A, Kobayashi Y, Takano T, Fukata S, Kuma K, et al. Serum dehydroepiandrosterone, dehydroepiandrosterone sulfate, and pregnenolone sulfate concentrations in patients with hyperthyroidism and hypothyroidism. Clin Chem. 2000;46:523-8.

Casson PR, Lindsay MS, Pisarska MD, Carson SA, Buster JE. Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: A case series. Hum Reprod. 2000;15:2129-32.

Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38(9):1165-74.

Maratou E. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol. 2009;160:785-90.

Dittrich R, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reprod Biomed Online. 2009;19:319-25.

Isidro ML, Penín MA, Nemiña R, Cordido F. Metformin reduces thyrotropin levels in obese, diabetic women with primary hypothyroidism on thyroxine replacement therapy. Endocrine. 2007;32:79-82.

Gleicher N, Barad DH. Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR) Reprod Biol Endocrinol. 2011;9:67.