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Meta-Analysis
. 2025 Mar 19;25(1):75.
doi: 10.1186/s12902-025-01896-2.

Prevalence of subclinical hypothyroidism in polycystic ovary syndrome and its impact on insulin resistance: a systematic review and meta-analysis

Arman Shekarian  1 , Sadegh Mazaheri-Tehrani  2   3   4 , Saba Shekarian  1 , Melika Pourbazargan  1 , Mahsa Setudeh  1 , Amir Parsa Abhari  4 , Mohammad Fakhrolmobasheri  4 , Maryam Heidarpour  5
Affiliations
Meta-Analysis

Prevalence of subclinical hypothyroidism in polycystic ovary syndrome and its impact on insulin resistance: a systematic review and meta-analysis

Arman Shekarian et al. BMC Endocr Disord. .

Abstract

Background: Although recent studies indicate a high prevalence of subclinical hypothyroidism (SCH) in women with polycystic ovary syndrome (PCOS), the reported prevalence rates vary widely. Therefore, we conducted this study to estimate the pooled prevalence of SCH among women with PCOS. Additionally, emerging evidence suggests that SCH may negatively impact insulin resistance in PCOS. Thus, we examined its effect on insulin resistance indices as our secondary objective.

Methods: We searched PubMed, Web of Science, Scopus, and Embase from their inception to February 25, 2024. Observational studies reporting the prevalence of SCH among women with PCOS were included. Joanna Briggs Institute's (JBI) critical appraisal checklist for prevalence studies was adopted for the risk of bias assessment. The random-effects model was employed to estimate the pooled prevalence with its 95% confidence intervals (CI). The weighted mean difference (WMD) was used to compare the insulin resistance indices between PCOS patients with and without SCH.

Results: Twenty-nine studies comprising 5765 women with PCOS were included. The meta-analysis demonstrated that 19.7% (95% CI: 16.1%; 23.5%) of women with PCOS have SCH. PCOS patients with SCH had significantly higher HOMA-IR (WMD = 0.78, 95% CI: 0.34; 1.22) and fasting insulin (WMD = 2.38, 95% CI: 0.34; 4.42) levels than those without SCH. Differences in fasting plasma glucose and 2-hour postprandial glucose did not reach statistical significance.

Conclusion: This systematic review and meta-analysis found that approximately 20% of women with PCOS have SCH. This underscores the need for regular thyroid function testing in these patients. The prevalence of SCH is influenced by the TSH cut-off used for diagnosis, highlighting the need for establishing a standardized TSH cut-off value. Furthermore, SCH significantly elevates the HOMA-IR index and fasting insulin levels, highlighting its potential impact on insulin resistance. Whether these metabolic changes are clinically important and put these individuals at higher risk of developing type 2 diabetes mellitus and cardiovascular disease requires further investigation.

Systematic review registration number in prospero: CRD42024510798.

Clinical trial number: Not applicable.

Keywords: Insulin resistance; Meta-analysis; PCOS; Polycystic ovary syndrome; Prevalence; Subclinical hypothyroidism.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the study selection process
Fig. 2
Fig. 2
Forest plot showing the pooled prevalence of subclinical hypothyroidism
Fig. 3
Fig. 3
Pooled prevalence of subclinical hypothyroidism with subgroup analysis by TSH upper limit
Fig. 4
Fig. 4
Forest plot showing the weighted mean difference of HOMA-IR between patients with and without subclinical hypothyroidism
Fig. 5
Fig. 5
Forest plot showing the weighted mean difference of fasting insulin levels between patients with and without subclinical hypothyroidism
See this image and copyright information in PMC

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