Polikistik over sendromu ve Hashimoto tiroiditi: Otoimmün bir ilişki

Yıl 2019, Cilt: 3 Sayı: 11, 790 - 792, 01.11.2019

Attila Önmez , Feyzi Gökosmanoğlu Erkan Aksoy

https://doi.org/10.28982/josam.560553

Öz

Amaç: Polikistik over sendromu (PKOS) ve Hashimoto tiroiditi (HT) sıklıkla birbirine eşlik eden yaygın hastalıklardır. Genetik, inflamasyon ve otoimmünite iki hastalığın arasındaki ilişkide mevcuttur. Bu çalışma otoimmünitenin PCOS ve HT arasındaki ilişkideki rolünü incelemektedir.

Yöntemler: Bu vaka-kontrol çalışması, Ordu Medical Park Hospital endokrinoloji ve jinekoloji bölümlerinde, Temmuz 2015 - Aralık 2018 arasında yapılmıştır. Rotterdam kriterlerine göre reprodüktif yaşlarda PKOS tanılı, HT tanılı kadınlar ve ne PCOS ne de HT tanısı olmayan sağlıklı gönüllüler çalışmaya dahil edildi. Üç grup arasında tiroid fonksiyon testleri, tiroid otoantikorları, gonadotropinler, androjen hormonları, açlık glukoz ve insülin düzeyleri ve vücut kitle indeksi (VKİ) karşılaştırıldı. Tüm hastalar ayrıca pelvik ve tiroid ultrason ile tarandı.

Bulgular: Çalışmaya toplamda beş yüz doksan altı kadın, PKOS grubunda 254, HT grubunda 190 ve kontrol grubunda 152 kişi dahil edildi. VKİ; PKOS ve HT grubunda kontrol grubundan anlamlı olarak daha yüksekti (sırasıyla P=0,012 ve P=0,027). Menstruel ve androjenik semptomlar hasta gruplarında kontrol grubundan anlamlı olarak daha yüksekti (P<0,001). TPOAb ve TgAb pozitifliği insidansı PKOS hastalarında kontrol grubuna göre anlamlı olarak yüksekti (P<0,001).

Sonuç: Bu araştırma PKOS hastalarında artmış TSH, anti-TPO ve anti-Tg düzeyleri ile birlikte HT sıklığının da yüksek olduğu gösterilmiştir. Çalışmamız, PKOS ya da HT hastalarının tiroid fonksiyonları ve overlerin ileri yaşamlarında taranması gerekliliğini göstermektedir.

Anahtar Kelimeler

Hashimato Tiroiditi, Polikistik over sendromu, Tiroid antikorları, Otoimmunite

Polycystic ovary syndrome and Hashimoto's thyroiditis: An autoimmune relationship

Öz

Aim: Polycystic ovary syndrome (PCOS) and Hashimoto’s thyroiditis (HT) are common and frequently comorbid diseases. A genetic predisposition and an inflammatory and autoimmune relationship have been posited between them. This study examines the role played by autoimmunity in the relation between PCOS and HT. 

Methods: This case-control study was conducted at the Medical Park Hospital endocrinology and gynecology departments, Ordu, Turkey, from July 2015 to December 2018. Reproductive-age women diagnosed with PCOS based on the Rotterdam criteria, women diagnosed with HT, and healthy women with neither PCOS nor HT were included in the study. Thyroid function tests, thyroid autoantibodies, gonadotropins, androgen hormones, fasting glucose and insulin levels, and body mass index (BMI) were compared among the three groups. All patients also underwent pelvic and thyroid ultrasound examinations. 

Results: Five hundred ninety-six women were included in the study, 254 in the PCOS group, 190 in the HT group, and 152 in the control group. BMI was significantly higher in the PCOS and HT groups than in the control group (P=0.012, and P=0.027, respectively). Menstrual and androgenic symptoms were also significantly higher in the patient groups than in the control group (P<0.001). The incidence of TPOAb and TgAb positivity was again significantly higher in the PCOS patients than in the controls (P<0.001). 

Conclusion: This research demonstrated a higher prevalence of HT, together with elevated TSH, anti-TPO, and anti-Tg levels in PCOS patients. Our data suggest that thyroid functions and ovaries should be screened later in life in patients with PCOS and HT.

Anahtar Kelimeler

Thyroid autoantibodies, Hashimoto’s thyroiditis, Polycystic ovary syndrome, Autoimmunity

Kaynakça

• 1. Söylemez S, Çaycı Sivri A, Şimşek E, Polat B, Çakır B. Melatonin, leptin, and ghrelin levels in nurses working night shifts. J Surg Med. 2019;3(1):22-6.
• 2. Karaköse M, Hepsen S, Çakal E, Saykı Arslan M, Tutal E, Akın Ş, et al. Frequency of nodular goiter and autoimmune thyroid disease and association of these disorders with insulin resistance in polycystic ovary syndrome. J Turk Ger Gynecol Assoc. 2017;18(2):85-9.
• 3. Boufas D, Vryonidou A, Mastorakos G, Ilias I. Thyroid function and autoimmunity versus number of pregnancies. J Reprod Infertil. 2016;17:240-2.
• 4. Chen CW, Huang YL, Huang RL, Tzeng CR, Chen CH. Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid. 2017;27:1194-200.
• 5. Geisthövel F, Rabe T. The ESHRE/ASRM consensus on polycystic ovary syndrome (PCOS)-an extended critical analysis. Reprod Biomed. 2007;14(4):522-35.
• 6. Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 2015;19(1):25-9.
• 7. Ganie MA, Khurana ML, Eunice M, Gupta N, Gulati M, Dwivedi SN, et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004; 89(6):2756-62.
• 8. Arora S, Sinha K, Kolte S, Mandal A. Endocrinal and autoimmune linkage: Evidences from a controlled study of subjects with polycystic ovarian syndrome. J Hum Reprod Sci 2016;9(1):18-22.
• 9. Idris I, O'Malley BP. Thyrotoxicosis in Down's and Turner's syndromes: the likelihood of Hashimoto's thyroiditis as the underlying aetiology. Int J Clin Pract. 2000;54(4):272-3.
• 10. Mohammed S, Awooda HA, Rayis DA, Hamdan HZ, Adam I, Lutfi MF. Thyroid function/antibodies in sudanese women with polycystic ovarian disease. Obstet Gynecol Sci. 2017;60(2):187-92.
• 11. Al-Saab R, Haddad S. Detection of thyroid autoimmunity markers in euthyroid women with polycystic ovary syndrome: a case-control study from syria. Int J Endocrinol Metab 2014;12(3):e17954.
• 12. Janssen OE, Mehlmauer N, Hahn S, Offner AH, Gärtner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004;150(3):363-9.
• 13. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Guidelines Committee, National Academy of Clinical Biochemistry. Thyroid. 2003;13(1):3-126.
• 14. Sinha U, Sinharay K, Saha 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):304–9.
• 15. Kowalczyk K, Franik G, Kowalczyk D, Pluta D, Blukacz Ł, Madej P. Thyroid disorders in polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2017;21(2):346-60.
• 16. Mobeen H, Afzal N, Kashif M. Polycystic Ovary Syndrome May Be an Autoimmune Disorder. Scientifica (Cairo). 2016;2016:4071735.
• 17. Arduc A, Aycicek Dogan B, Bilmez S, Imga Nasiroglu N, Tuna MM, Isik S, et al. High prevalence of Hashimoto's thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015;40(4):204-10.
• 18. Petrikova J, Lazurova I, Dravecka I, Vrbikova J, Kozakova D, Figurova J, et al. The prevalence of non organ specific and thyroid autoimmunity in patients with polycystic ovary syndrome. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):302-6.
• 19. Romitti M, Fabris VC, Ziegelmann PK, Maia AL, Spritzer PM. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr Connect. 2018;26;7(11):1158-67.