Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 3:14:1245106.
doi: 10.3389/fendo.2023.1245106. eCollection 2023.

The prevalence of thyroid dysfunction and hyperprolactinemia in women with PCOS

Kim van der Ham  1 , Karlijn J Stekelenburg  1 , Yvonne V Louwers  1 , Wendy van Dorp  1 , Marco W J Schreurs  2 , Ronald van der Wal  3 , Régine P M Steegers-Theunissen  4 , Joop S E Laven  1
Affiliations

The prevalence of thyroid dysfunction and hyperprolactinemia in women with PCOS

Kim van der Ham et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Ovulatory dysfunction is usually caused by an endocrine disorder, of which polycystic ovary syndrome (PCOS) is the most common cause. PCOS is usually associated with estrogen levels within the normal range and can be characterized by oligo-/anovulation resulting in decreased progesterone levels. It is suggested that decreased progesterone levels may lead to more autoimmune diseases in women with PCOS. In addition, it is often claimed that there is an association between hyperprolactinemia and PCOS. In this large well-phenotyped cohort of women with PCOS, we have studied the prevalence of thyroid dysfunction and hyperprolactinemia compared to controls, and compared this between the four PCOS phenotypes.

Methods: This retrospective cross-sectional study contains data of 1429 women with PCOS and 299 women without PCOS. Main outcome measures included thyroid stimulating hormone (TSH), Free Thyroxine (FT4), and anti-thyroid peroxidase antibodies (TPOab) levels in serum, the prevalence of thyroid diseases and hyperprolactinemia.

Results: The prevalence of thyroid disease in PCOS women was similar to that of controls (1.9% versus 2.7%; P = 0.39 for hypothyroidism and 0.5% versus 0%; P = 0.99 for hyperthyroidism). TSH levels were also similar (1.55 mIU/L versus 1.48 mIU/L; P = 0.54). FT4 levels were slightly elevated in the PCOS group, although within the normal range (18.1 pmol/L versus 17.7 pmol/L; P < 0.05). The prevalence of positive TPOab was similar in both groups (5.7% versus 8.7%; P = 0.12). The prevalence of hyperprolactinemia was similarly not increased in women with PCOS (1.3%% versus 3%; P = 0.05). In a subanalysis of 235 women with PCOS and 235 age- and BMI-matched controls, we found no differences in thyroid dysfunction or hyperprolactinemia. In according to differences between PCOS phenotypes, only the prevalence of subclinical hypothyroidism was significantly higher in phenotype B (6.3%, n = 6) compared to the other phenotypes.

Conclusion: Women with PCOS do not suffer from thyroid dysfunction more often than controls. Also, the prevalence of positive TPOab, being a marker for future risk of thyroid pathology, was similar in both groups. Furthermore, the prevalence of hyperprolactinemia was similar in women with PCOS compared to controls.

Keywords: PCOS; TPOab; hyperprolactinemia; reproductive disorders; thyroid dysfunction.

PubMed Disclaimer

Conflict of interest statement

JL reports grants from Ansh Labs, Webster, Tx, USA, from Ferring, Hoofddorp, NL, from Dutch Heart Association, Utrecht, NL, from Zon MW, Amsterdam, NL, from Roche Diagnostics, Rothkreuz, Switzerland and personal fees from Ferring, Hoofddorp, NL, from Titus Healthcare, Hoofddorp, NL, from Gedeon Richter, Groot-Bijgaarden, Belgium, and is an unpaid board member and president of the AE-PCOS Society, outside the submitted work. The remaining author(s) declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
TSH and FT4 levels of the different PCOS phenotypes (A) TSH levels in serum of women with PCOS divided and compared between the four phenotypes. (B) FT4 levels in serum of women with PCOS divided and compared between the four phenotypes. 24 women were excluded, only for comparing TSH and FT4 levels,because of thyroid medication use. TSH, thyroid-stimulating hormone; FT4, Free Thyroxine; Phenotype A, hyperandrogenism + ovulatory dysfunction + polycystic ovaries; Phenotype B, hyperandrogenism + ovulatory dysfunction; Phenotype C, hyperandrogenism + polycystic ovaries; Phenotype D, ovulatory dysfunction + polycystic ovaries. The dots and the stars in this figure mean outliers. Dots mean outliers including the formula: IQR * 1.5. The stars mean far outliers, including the formula: IQR * 3.0. This is a setting in SPSS by default.
Figure 2
Figure 2
Frequency of thyroid diseases in the PCOS phenotypes Phenotype A, hyperandrogenism + ovulatory dysfunction + polycystic ovaries; Phenotype B, hyperandrogenism + ovulatory dysfunction; Phenotype C, hyperandrogenism + polycystic ovaries; Phenotype D, ovulatory dysfunction + polycystic ovaries. *Phenotype B had significantly higher prevalence of subclinical hypothyroidism compared to the other phenotypes (P < 0.05).
See this image and copyright information in PMC

References

    1. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril (2016) 106(1):6–15. doi: 10.1016/j.fertnstert.2016.05.003 - DOI - PubMed
    1. Ganie M, Vasudevan V, Wani I, Baba M, Arif T, Rashid A. Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian J Med Res (2019) 150(4):333–44. doi: 10.4103/ijmr.IJMR_1937_17 - DOI - PMC - PubMed
    1. Kachuei M, Jafari F, Kachuei A, Keshteli AH. Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet (2012) 285(3):853–6. doi: 10.1007/s00404-011-2040-5 - DOI - PubMed
    1. Janssen OE, Mehlmauer N, Hahn S, Offner AH, Gärtner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol (2004) 150(3):363–9. doi: 10.1530/eje.0.1500363 - DOI - PubMed
    1. Grossman CJ. Regulation of the immune system by sex steroids. Endocr Rev (1984) 5(3):435–55. doi: 10.1210/edrv-5-3-435 - DOI - PubMed