Giusti Massimo, Mittica Miranda
Endocrine Unit, Clinical Diagnostic Centre Priamar, via dei Partigiani 13R, 17100, Savona, Italy.
Department of Internal Medicine, University of Genova, Genoa, Italy.
Thyroid Res. 2022 Aug 15;15(1):15. doi: 10.1186/s13044-022-00133-5.
AMH is a reliable index of ovarian reserve. It is not clear whether, or how much, thyroid function and/or thyroid autoimmunity can impair ovarian function and AMH secretion in the long term.
This retrospective cross-sectional study compared AMH levels in pre-menopausal women with/without positive thyroid autoimmunity or hypofunction.
From January 2019 to May 2022, AMH was evaluated in 250 pre-menopausal women not undergoing assisted fertility procedures who were referred to a secondary endocrine centre. Thyroid function and autoimmunity, sonographically measured thyroid volume, FSH and E2 in the early follicular phase, and PRL and progesterone in the luteal phase were also evaluated. Exclusion criteria were: age < 18 years, genetic hypogonadism, pregnancy and previous treatments that have potentially damaging effects on gonads.
We evaluated 171 women (mean age ± SD: 31.5 ± 9.0 years) off L-T4 treatment and 79 women on L-T4 treatment (39.7 ± 9.5 years; P < 0.001). AMH (median, IQR, CI) was 16.1 pmol/l (7.1 - 35.7 pmol/l, 21.4 - 29.9 pmol/l) and 7.6 pmol/l (1.4 - 17.8 pmol/l, 8.6 - 14.7 pmol/l; P < 0.001), respectively. When the women were stratified according to age (18-25, 26-30, 31-35, 36-40, 41-45, > 46 years) no significant difference emerged between those on/off L-T4 treatment in groups of the same age-range. In women on- or off-L-T4 treatment, AMH was negatively related with age on univariate and multivariate analyses (P < 0.0001). In both groups, AMH was negatively related to FSH (P < 0.0001). On multivariate analysis, AMH was positively related to the age of the mother on spontaneous menopause (P = 0.006) and negatively to thyroid volume (P = 0.02) in women on L-T4. AMH levels were significantly (P = 0.03) higher in TPOAb-negative than in TPOAb-positive women, but age was significantly (P = 0.001) lower in TPOAb-negative than in TPOAb-positive women.
In our cohort of women, age proved to be a better predictor of AMH levels than any of the other factors linked to thyroid function and autoimmunity. Our data do not support the hypothesis that subclinical hypothyroidism and/or autoimmunity are associated with decreased ovarian reserve. However, a larger number of cases is needed in order to obtain conclusive data.
抗缪勒管激素（AMH）是卵巢储备功能的可靠指标。目前尚不清楚甲状腺功能和/或甲状腺自身免疫在长期内是否会损害卵巢功能及AMH分泌，以及损害程度如何。
这项回顾性横断面研究比较了有/无甲状腺自身免疫阳性或功能减退的绝经前女性的AMH水平。
2019年1月至2022年5月，对250名未接受辅助生殖治疗且被转诊至二级内分泌中心的绝经前女性进行了AMH评估。同时还评估了甲状腺功能和自身免疫、超声测量的甲状腺体积、卵泡早期的促卵泡生成素（FSH）和雌二醇（E2），以及黄体期的泌乳素（PRL）和孕酮。排除标准为：年龄<18岁、遗传性性腺功能减退、妊娠以及既往有对性腺有潜在损害作用的治疗。
我们评估了171名未接受左甲状腺素（L-T4）治疗的女性（平均年龄±标准差：31.5±9.0岁）和79名接受L-T4治疗的女性（39.7±9.5岁；P<0.001）。AMH（中位数、四分位数间距、可信区间）分别为16.1pmol/L（7.1 - 35.7pmol/L，21.4 - 29.9pmol/L）和7.6pmol/L（1.4 - 17.8pmol/L，8.6 - 14.7pmol/L；P<0.001）。当根据年龄（18 - 25岁、26 - 30岁、31 - 35岁、36 - 40岁、41 - 45岁、>46岁）进行分层时，同一年龄段接受/未接受L-T4治疗的女性之间未出现显著差异。在接受或未接受L-T4治疗的女性中，单因素和多因素分析显示AMH与年龄呈负相关（P<0.0001）。在两组中，AMH均与FSH呈负相关（P<0.0001）。多因素分析显示，在接受L-T4治疗的女性中，AMH与自然绝经时母亲的年龄呈正相关（P = 0.006），与甲状腺体积呈负相关（P = 0.02）。抗甲状腺过氧化物酶抗体（TPOAb）阴性的女性AMH水平显著高于TPOAb阳性的女性（P = 0.03），但TPOAb阴性的女性年龄显著低于TPOAb阳性的女性（P = 0.001）。
在我们的女性队列中，年龄被证明是比任何与甲状腺功能和自身免疫相关的其他因素更好的AMH水平预测指标。我们的数据不支持亚临床甲状腺功能减退和/或自身免疫与卵巢储备功能下降相关的假设。然而，需要更多病例才能获得确凿数据。
