Division of Gynecology, Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy.
Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Front Endocrinol (Lausanne). 2023 Aug 11;14:1251866. doi: 10.3389/fendo.2023.1251866. eCollection 2023.
Published data on the relationship between polycystic ovary syndrome (PCOS) and thyroid dysfunction are sparse and confusing.
To comprehensively review data available in the literature regarding the relationship between PCOS and the thyroid function, and its abnormalities.
Nine main areas of interest were identified and analyzed according to the available evidence: 1) Evaluation of thyroid function for PCOS diagnosis; 2) Epidemiology data on thyroid function/disorders in patients with PCOS, and vice versa; 3) Experimental data supporting the relationship between thyroid function/disorders and PCOS; 4) Effects of thyroid function/disorders on PCOS features, and vice versa; 5) Effect of thyroid alterations on the cardiometabolic risk in women with PCOS; 6) Effect of thyroid abnormalities on reproductive outcomes in women with PCOS; 7) Relationship between thyroid function/abnormalities in patients with PCOS who are undergoing fertility treatment; 8) Effect of treatments for thyroid diseases on PCOS; and 9) Effect of treatments for PCOS on thyroid function. An extensive literature search for specific keywords was performed for articles published from 1970 to March 2023 using PubMed and Web of Science. Data were reported in a narrative fashion.
PCOS is a diagnosis of exclusion for which diagnosis is possible only after excluding disorders that mimic the PCOS phenotype, including thyroid dysfunctions. However, the tests and the cutoff values used for this are not specified. Many experimental and clinical data suggest a relationship between perturbations of the thyroid function and PCOS. Direct and unequivocal evidence on the effects of thyroid function/disorders on PCOS features are lacking. High thyroid-stimulating hormone levels and subclinical hypothyroidism may be associated with significant worsening of several intermediate endpoints of cardiometabolic risk in women with PCOS. Thyroid abnormalities may worsen reproductive outcomes, especially in patients undergoing fertility treatment. To date, there are no data demonstrating the efficacy of thyroid medications on fertility and cardiometabolic risk in women with PCOS. Lifestyle modification changes, metformin, and vitamin D seem to improve thyroid function in the general population.
PCOS and thyroid disorders are closely related, and their coexistence may identify patients with a higher reproductive and metabolic risk. Regular screening for thyroid function and thyroid-specific autoantibodies in women with PCOS, particularly before and during pregnancy, is highly recommended.
多囊卵巢综合征（PCOS）与甲状腺功能障碍之间关系的相关数据有限且令人困惑。
全面回顾文献中关于 PCOS 与甲状腺功能及其异常之间关系的现有数据。
根据现有证据，确定并分析了 9 个主要研究领域：1）评估甲状腺功能用于 PCOS 的诊断；2）PCOS 患者和反之甲状腺功能/障碍的流行病学数据；3）支持甲状腺功能/障碍与 PCOS 之间关系的实验数据；4）甲状腺功能/障碍对 PCOS 特征的影响，反之亦然；5）甲状腺改变对患有 PCOS 的女性的心血管理论风险的影响；6）甲状腺异常对患有 PCOS 的女性生殖结局的影响；7）接受生育治疗的 PCOS 患者甲状腺功能/异常的关系；8）甲状腺疾病治疗对 PCOS 的影响；9）PCOS 治疗对甲状腺功能的影响。从 1970 年到 2023 年 3 月，使用 PubMed 和 Web of Science 针对特定关键词进行了广泛的文献检索。以叙述方式报告数据。
PCOS 是一种排除性诊断，只有在排除了模仿 PCOS 表型的疾病后，包括甲状腺功能障碍，才能做出诊断。然而，用于此目的的测试和截止值并未指定。许多实验和临床数据表明，甲状腺功能紊乱与 PCOS 之间存在关系。缺乏关于甲状腺功能/障碍对 PCOS 特征影响的确切和明确的证据。高促甲状腺激素水平和亚临床甲状腺功能减退症可能与患有 PCOS 的女性几种心血管代谢风险中间终点显著恶化相关。甲状腺异常可能会恶化生殖结局，尤其是在接受生育治疗的患者中。迄今为止，尚无数据表明甲状腺药物对患有 PCOS 的女性的生育和心血管代谢风险有效。生活方式改变、二甲双胍和维生素 D 似乎可以改善普通人群的甲状腺功能。
PCOS 和甲状腺疾病密切相关，两者共存可能会识别出具有更高生殖和代谢风险的患者。强烈建议对患有 PCOS 的女性，尤其是在怀孕前和怀孕期间，定期筛查甲状腺功能和甲状腺特异性自身抗体。
