Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy.
J Endocrinol Invest. 2020 Sep;43(9):1181-1188. doi: 10.1007/s40618-020-01230-8. Epub 2020 Mar 26.
Thyroid gland dysfunction represents an epidemiologically relevant disease in the female gender, where treatment with oral contraceptives (OCs) is frequently prescribed. Although OCs are able to impact the thyroid gland function, scanty data have been released on this matter so far.
The aim of this article was to review how hormonal OCs, including estrogen- or progesterone-only containing medications, interact with the hepatic production of thyroid-binding globulin (TBG) and, consequently, their effects on serum levels of thyroxine (T4) and triiodothyronine (T3). We also reviewed the effect of Levo-T4 (LT4) administration in women taking OCs and how they influence the thyroid function in both euthyroid women and in those receiving LT4.
The estrogenic component of the pills is capable of increasing various liver proteins, such as TBG, sex hormone-binding protein (SHBG) and coagulation factors. On the other hand, the role of progestogens is to modulate estrogen-dependent effects mainly through their anti-androgenic action. In fact, a reduction in the effects of androgens is useful to keep the thromboembolic and cardiovascular risks low, whereas OCs increase it especially in women with subclinical hypothyroidism or in those treated with LT4. Accordingly, subclinical hypothyroidism is known to be associated with a higher mean platelet volume than normal and this increases cardiovascular risk due to platelet hyperactivity caused by incomplete thrombocytopoietic maturation.
甲状腺功能障碍是女性中一种具有流行病学相关性的疾病，常为其开具口服避孕药（OC）进行治疗。尽管 OC 能够影响甲状腺功能，但目前关于这方面的数据还很少。
本文旨在回顾激素 OC，包括仅含雌激素或孕激素的药物，如何与肝脏产生甲状腺结合球蛋白（TBG）相互作用，以及它们对血清中甲状腺素（T4）和三碘甲状腺原氨酸（T3）水平的影响。我们还回顾了 LT4 在服用 OC 的女性中的应用及其对甲状腺功能的影响，包括甲状腺功能正常的女性和 LT4 治疗的女性。
药丸中的雌激素成分能够增加多种肝脏蛋白，如 TBG、性激素结合球蛋白（SHBG）和凝血因子。另一方面，孕激素的作用主要通过其抗雄激素作用来调节雌激素依赖性作用。事实上，降低雄激素的作用有助于降低血栓栓塞和心血管风险，而 OC 则会增加这种风险，尤其是在亚临床甲状腺功能减退的女性或服用 LT4 的女性中。因此，亚临床甲状腺功能减退症与正常情况下相比，平均血小板体积更高，这会由于血小板生成不完全导致血小板活性增加而增加心血管风险。
