PCOS and Autoimmune Thyroid Disease

There are many studies to date to confirm the higher prevalence of thyroid disease in patient’s struggling with PCOS.

An interesting study done recently not only confirmed this association, it also demonstrated the impact of autoimmune thyroid disease (ATD), known as Hashimoto’s disease, on specific metabolic and hormone markers in patient’s with PCOS.

827 PCOS patient’s struggling with reproductive and metabolic complaints were assessed for ATD using laboratory testing and thyroid ultrasound. These tests are not routinely run by your medical doctor and should be considered in all cases of infertility, specifically in patients with current thyroid issues, recurrent miscarriage, and PCOS. More about thyroid tests here.

It should also be noted that patient’s presenting with primarily thyroid issues were excluded from this study.

Results showed women struggling with both PCOS and ATD had a lower prevalence of elevated testosterone, free androgen index and hyperandrogenemia. These women also reported less symptoms of hirsutism (hair growth) compared to women presenting with just PCOS.

Acne, alopecia, and oligomenorrhea (menstrual cycles longer than 35 days) prevalence was the same across the two patient groups.

Higher rates of obesity were associated with patients having ATD and PCOS. Along with higher BMI being correlated to higher TSH levels, although in this study, all patients had normal functioning thyroid levels (euthyroid).

In summary, patients with PCOS have a higher incidence of ATD and are at greater risk for metabolic disorders. Symptoms of androgen excess appear to be less associated with patients presenting with both ATD and PCOS.

This study also signifies how multifaceted PCOS can be. Patients may not present with the same set of symptoms, therefore a full work-up is necessary to rule in/out PCOS in every case. The new international evidence-based guideline for the assessment and management of PCOS repeatedly states:

“ Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS.”

It is over diagnosed in many patients and an ultrasound alone cannot determine if you have PCOS.

The guideline also states that ultrasound should not be used for the diagnosis of PCOS in those with a gynaecological age of less than 8 years, since at this life stage, there is a higher incidence of multi-follicular ovaries. This can lead to a misdiagnosis and unnecessary treatment. The guideline goes in great detail describing other various practices methods and assessment tools that are important when diagnosing PCOS.

One drawback of this report is no mention of thyroid testing when assessing a patient with possible PCOS. Not only that, patients with possible ATD. The higher prevalence of thyroid disease in PCOS patients should require a full thyroid work-up to determine the right course of treatment.

In good health,

Dr. Kirti Deol