Seasonal Changes of Thyroid Function Parameters in Women of Reproductive Age Between 2012 and 2018: A Retrospective, Observational, Single-Center Study

Abstract

Background: Thyroid function can be influenced by external stimuli such as light and temperature. However, it is currently unknown whether there is seasonal variation of thyroid function in women of reproductive age. Adequate thyroid function in reproductive-aged women is necessary for optimal fetal-maternal outcomes. Therefore, this study aims to evaluate the seasonal changes in levels of thyrotropin (TSH), free triiodothyronine (FT₃), free thyroxine (FT₄), and TSH index (TSHI) in women of reproductive age.

Methods: A large retrospective study was conducted that included women aged 20-49 years who visited our outpatient or checkup center between 2012 and 2018. Thyroid function was measured using the automated immunochemiluminescent assay kit. Subjects with overt thyroid dysfunction, pregnancy, thyroid disease, cancer, and severe infectious or psychological disease were excluded. Seasonal differences of thyroid function were analyzed using the Kruskal-Wallis test or the analysis of means with transformed ranks. Spearman's correlation was performed to evaluate the association between thyroid function parameters and age. A subset of 181 subjects was included in the longitudinal analyses. Differences in thyroid function between summer and winter were analyzed using the Wilcoxon signed-rank test.

Results: A total of 48,990 women with a median age of 39 years were included. The prevalence of subclinical hypothyroidism was lower in summer but higher in winter (5.6% vs. 7.0%, p < 0.05). The TSH, FT₃, and FT₄ levels and TSHI reached a peak in winter, while they declined to trough in summer. The TSH concentrations (r = 0.044, p < 0.001) and TSHI (r = 0.025, p < 0.001) were positively correlated with age, whereas FT₃ (r = -0.073, p < 0.001) and FT₄ (r = -0.059, p < 0.001) were negatively correlated with age. The associations of thyroid parameters with age were similar between subjects with positive thyroid peroxidase antibody (TPOAb) and those with negative TPOAb. In the matched longitudinal analysis of 181 subjects, no differences were detected in the thyroid parameters between summer and winter.

Conclusions: This retrospective single-center study showed that thyroid hormone levels and central sensitivity to thyroid hormones are influenced by age and seasonal fluctuations among women of reproductive age, while their impact on reproductive health remains to be elucidated in future studies.

Keywords: big data; reproductive health; seasonal changes; thyroid hormones; thyrotropin.

Figure 1

Flowchart of study participant inclusion and exclusion. Abbreviations: TSH, thyrotropin; FT₃, free triiodothyronine; FT₄, free thyroxine; TPOAb, thyroid peroxidase antibody.

Figure 2

Time series plot of thyroid parameters over 7 years. The distribution (row 1), seasonal trend (row 2), time trend (row 3), and residuals (row 4) are shown for (A) TSH, (B) FT₄, (C) FT₃ levels, and (D) TSHI. Abbreviations: Sp, Spring; Su, Summer, Au, Autumn; Wi, Winter; TSH, thyrotropin; FT₃, free triiodothyronine; FT₄, free thyroxine; TSHI, TSH index.

Figure 3

Comparisons of TSH, FT₄, FT₃, and TSHI between summer and winter in longitudinal analysis. Box plot indicates upper and lower quartiles (box) with median (central line). Whiskers indicate upper and lower extremes. Abbreviations: TSH, thyrotropin; FT₃, free triiodothyronine; FT₄, free thyroxine; TSHI, TSH index; TPOAb, thyroid peroxidase antibody.