Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Thyroid. 2024 Nov;34(11):1424-1434. doi: 10.1089/thy.2024.0245. Epub 2024 Oct 28.
The impact of thyroid dysfunction (TD) on the female reproductive system has been extensively documented. While there is evidence suggesting that alteration in female reproductive status may affect thyroid function, conflicting results have prevented definitive conclusions. This study aimed to investigate the associations of parity, spontaneous abortion (mentioned as abortion throughout this study), and menopause status with the prevalence and incidence of TD. From the Tehran thyroid study population, 2711 participants were included in the cross-sectional analysis to explore associations between female reproductive status and TD. Overall, 2191 participants with euthyroid were included in the survival study and followed up in 3-year intervals. Multinomial logistic regression was adopted in cross-sectional analysis and multivariable Cox proportional hazard model was used to determine associations between the incidence of TD with parity, abortion, and menopause status, adjusting for age, smoking, body mass index, and thyroid peroxidase antibodies positivity. At the baseline, multiple parities (≥4) were significantly associated with overt hypothyroidism (odds ratio [OR] = 1.12; confidence interval [CI] 1.0-1.26) and subclinical hyperthyroidism (OR = 1.11 [CI 1.03-1.21]). Furthermore, multiple abortions were associated with overt hyperthyroidism (OR = 2.09 [CI 1.02-4.26]). Over the course of the study, multiple parities were significantly associated with the incident subclinical and clinical hypothyroidism. Conversely, a history of abortion was associated with a reduced risk of incident overt hypothyroidism. We found no significant association between menopause status and the prevalence or incidence of either hypothyroidism or hyperthyroidism. Our results suggest that the female reproductive system may be associated with thyroid function. Parity and abortion are associated with the occurrence of TD. A deeper understanding of the underlying mechanisms of the cellular and molecular alterations in signaling cascades during pregnancy is necessary to fully elucidate these associations.
甲状腺功能障碍（TD）对女性生殖系统的影响已得到广泛证实。虽然有证据表明女性生殖状态的改变可能会影响甲状腺功能，但相互矛盾的结果使得无法得出明确的结论。本研究旨在调查生育、自然流产（在本研究中简称流产）和绝经状态与 TD 患病率和发病率的关系。
在德黑兰甲状腺研究人群中，共有 2711 名参与者纳入横断面分析，以探讨女性生殖状态与 TD 之间的关系。共有 2191 名甲状腺功能正常的参与者纳入生存研究，并以 3 年为间隔进行随访。在横断面分析中采用多项逻辑回归，在多变量 Cox 比例风险模型中调整年龄、吸烟、体重指数和甲状腺过氧化物酶抗体阳性后，确定生育、流产和绝经状态与 TD 发病率之间的关系。
在基线时，多次生育（≥4 次）与显性甲状腺功能减退（OR=1.12；95%CI 1.0-1.26）和亚临床甲状腺功能亢进（OR=1.11；95%CI 1.03-1.21）显著相关。此外，多次流产与显性甲状腺功能亢进相关（OR=2.09；95%CI 1.02-4.26）。在研究期间，多次生育与亚临床和临床甲状腺功能减退的发生显著相关。相反，流产史与发生显性甲状腺功能减退的风险降低相关。我们没有发现绝经状态与甲状腺功能减退或甲状腺功能亢进的患病率或发病率之间存在显著关联。
我们的研究结果表明，女性生殖系统可能与甲状腺功能有关。生育和流产与 TD 的发生有关。为了充分阐明这些关联，需要深入了解妊娠期间细胞和分子信号转导变化的潜在机制。
