ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORİJİNAL ARAŞTIRMALAR

Polikistik Over Sendromlu Hastalarda Subklinik Hipotiroidi Varlığının İnsülin Direnci ve Dislipidemi Üzerine Etkileri
Investigation of the Effects of Subclinic Hypothyroidism on Insulin Resistance and Dyslipidemia in Patients with Polycystic Ovary Syndrome
Received Date : 03 Apr 2023
Accepted Date : 24 May 2023
Available Online : 30 May 2023
Doi: 10.24074/tjrms.2023-97209 - Makale Dili: TR
TJRMS. 2023;7(3):81-8
ÖZET
Amaç: Polikistik Over Sendromu prevalansı yüksek olan ve metabolik etkileri nedeniyle yaşam boyu takip gerektiren multisistemik bir hastalıktır. Subklinik hipotiroidinin de PKOS’a benzer bazı metabolik riskler taşıdığı düşünülmektedir. Biz çalışmamız ile subklinik hipotiroidinin PKOS hastalarında hormonal parametreler, lipit profili ve insülin direnci düzeyleri üzerindeki etkisini ve bunlara bağlı olarak uzun dönem metabolik sonuçlar açısından bu hasta grubunda ek bir risk faktörü olup olmadığını incelemeyi amaçladık. Gereç ve Yöntemler: Bu çalışma bir kesitsel vaka kontrol çalışmasıdır. Ankara Şehir Hastanesi’ne Mayıs 2021-Eylül 2021 tarihleri arasında başvuran PKOS ve subklinik hipotiroidisi olan 18-40 yaş arası 53 kadın grup 1; PKOS olup ötiroid olan 18-40 yaş arası 53 kadın grup 2; tamamen sağlıklı olan 54 kadın kontrol grubu olarak ele alınmıştır. Her hastanın serum TSH, T4, FSH, LH, E2, Total testosteron, AMH, Açlık glukoz, Açlık insülin, Trigliserit, Total kolesterol, LDL, HDL, VLDL düzeylerine bakılmış, LH/FSH oranı ve HOMA-IR değerleri hesaplanmıştır. Bulgular: SCH’nin klinik tabloya eklenmesi sonucunda açlık insülin, HOMA-IR, insülin rezistansı varlığı, AMH ve total testosteron düzeyleri anlamlı olarak etkilenmiştir. VKİ, LH, LH/FSH oranı, trigliserid, HDL ve VLDL düzeylerinde ise PKOS’lu gruplar ile sağlıklı kontrol grubu arasında anlamlı farklar gözlenmiştir. Sonuç: Elde ettiğimiz verilere göre; subklinik hipotiroidi TSH 2,5-4,0 mIU/L aralığında olduğunda bile, PKOS’un özellikle insülin direnci ve glukoz metabolizması üzerindeki olumsuz etkilerini belirginleştirmektedir. Bu sonuç, subklinik hipotiroidi ve PKOS’un birlikte bulunduğu hasta popülasyonunda ek önlemlere ve tedavi modalitelerine gereksinim olduğunu düşündürmektedir.
ABSTRACT
Objective: Polycystic Ovary Syndrome is a multisystemic disease with a high prevalence and requires lifelong follow-up due to its metabolic effects. Subclinical hypothyroidism is thought to carry some metabolic risks similar to PCOS. The co-existence of both endocrinological disorders may increase these risks and may require changes in follow-up and treatment modalities. In our study, we aimed to examine the effect of subclinical hypothyroidism on hormonal parameters, lipid profile and insulin resistance levels in PCOS patients and whether there is an additional risk factor in this patient group in terms of long-term metabolic outcomes. Materials and Methods: This study was designed as a cross-sectional case-control study consisting of three groups. Group 1 of 53 women aged 18-40 years with PCOS and subclinical hypothyroidism who applied to Ankara City Hospital Reproductive Endocrinology Clinic between May 2021 and September 2021; 53 women aged 18-40 years with PCOS who were euthyroid group 2; 54 completely healthy women were taken as the control group. Each patient's serum TSH, T4, FSH, LH, E2, Total testosterone, AMH, Fasting glucose, Fasting insulin, Triglyceride, Total cholesterol, LDL, HDL, VLDL levels were checked, LH/FSH ratio and HOMA-IR values were calculated. Results: As a result of our study, fasting insulin, HOMA-IR, presence of insulin resistance, AMH and total testosterone levels were significantly affected. Significant differences were observed between the PCOS groups and the healthy control group in BMI, LH, LH/FSH ratio, triglyceride, HDL and VLDL levels. Conclusion: According to the data we obtained as a result of our study; even the TSH levels are in the range of 2.5-4.0 mIU/L, subclinical hypothyroidism highlights the negative effects of PCOS, especially on insulin resistance and glucose metabolism. This results suggest that additional precautions and treatment modalities are needed in the patient population with subclinical hypothyroidism and PCOS.
REFERANSLAR
  1. Anagnostis P, Tarlatzis BC, R. P. Kauffman, "Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences," Metabolism. 2018;86:33-43. [Crossref]  [PubMed] 
  2. Sinha U, Sinharay K, Saha S, Longkumer TA, Baul S, Pal S. "Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India," Indian J. Endocrinol. Metab. 2013;17(2):304. [Crossref]  [PubMed]  [PMC] 
  3. Yu Q, Wang JB, "Subclinical Hypothyroidism in PCOS: Impact on Presentation, Insulin Resistance, and Cardiovascular Risk," Biomed Res. Int. 2016 (3):1-7. [Crossref]  [PubMed]  [PMC] 
  4. Enzevaei A, Salehpour S, Tohidi M, Saharkhiz N. Subclinical hypothyroidism and insulin resistance in polycystic ovary syndrome: is there a relationship? Iran J Reprod Med. 2014;12(7):481-6.
  5. Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, Koukkou E, Tzanela M, Thalassinos N, Raptis SA. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab. 2006;91(12):4930-7. [Crossref]  [PubMed] 
  6. Brenta G, Berg G, Arias P, Zago V, Schnitman M, Muzzio ML, Sinay I, Schreier L. Lipoprotein alterations, hepatic lipase activity, and insulin sensitivity in subclinical hypothyroidism: response to L-T(4) treatment. Thyroid. 2007;17 (5):453-60. [Crossref]  [PubMed] 
  7. Celik C, Abali R, Tasdemir N, Guzel S, Yuksel A, Aksu E, Yılmaz M. Is subclinical hypothyroidism contributing dyslipidemia and insulin resistance in women with polycystic ovary syndrome? Gynecol Endocrinol. 2012;28(8):615-8. [Crossref]  [PubMed] 
  8. Dittrich R, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reprod Biomed Online. 2009;19(3):319-25. [Crossref]  [PubMed] 
  9. Mueller A, Schöfl C, Dittrich R, Cupisti S, Oppelt PG, Schild RL, Beckmann MW, Häberle L. Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome. Hum Reprod. 2009;24(11):2924-30. [Crossref]  [PubMed] 
  10. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160(4):526-34. [Crossref]  [PubMed] 
  11. Broekmans FJ, Visser JA, Laven JS, Broer SL, Themmen AP, Fauser BC. Anti-Müllerian hormone and ovarian dysfunction. Trends Endocrinol Metab. 2008;19(9):340-7. [Crossref]  [PubMed] 
  12. Fatima M, Amjad S, Sharaf Ali H Sr, Ahmed T, Khan S, Raza M, Inam M. Correlation of Subclinical Hypothyroidism With Polycystic Ovary Syndrome (PCOS). Cureus. 2020;12(5):e8142. [Crossref] 
  13. Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T, Zhu D, Bi Y. Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age. Gynecol Endocrinol. 2018;34(10):875-9. [Crossref]  [PubMed]