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Agaoglu Z, Cevher Akdulum MF, Ozturk Agaoglu M, Mursel K, Karabacak RO. The effect of levothyroxine and prednisolone treatment on pregnancy in in vitro fertilization patients with positive thyroid autoantibodies. J Obstet Gynaecol Res 2024; 50:941-947. [PMID: 38491874 DOI: 10.1111/jog.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
AIM To investigate the effects of levothyroxine and prednisolone treatment, or in combination, on positive thyroid autoantibodies in infertile patients undergoing in vitro fertilization (IVF) therapy. METHODS This retrospective study included a total of 190 patients with positive thyroid autoantibodies (anti-T and anti-TPO) who underwent IVF treatment between January 2008 and March 2016. Patients were divided into four groups: group 1-levothyroxine group (n = 50), group 2-prednisolone group (n = 50), group 3-levothyroxine and prednisolone combination (n = 25), group 4-control group (n = 65). Anti-T and anti-TPO levels before IVF and at the time of embryo transfer (ET), b-hcg positivity, clinical and biochemical pregnancy, miscarriage rate, and live birth rate were compared among groups. RESULTS In levothyroxine-treated group, mean anti-TPO levels significantly decreased at the time of ET compared to before IVF treatment levels (p = 0.036). In group 3, mean anti-T and anti-TPO levels significantly decreased at the time of ET compared to levels before IVF treatment (p < 0.05). Patients who became pregnant in group 1, mean anti-T anti-TPO levels significantly decreased compared to before IVF treatment levels (p < 0.05). The biochemical pregnancy rate was significantly higher in group 2 (p = 0.03). Abortion rates were the highest in group 3, but no significant difference was found among groups. The group treated with levothyroxine had a significantly increased rate of live birth compared to the control group (p = 0.02). CONCLUSIONS Levothyroxine addition during IVF treatment of patients with positive thyroid antibodies in subclinical hypothyroidism increases the take-home baby pregnancy rate. Whether subclinical hypothyroidism or not in IVF treatment, levothyroxine is more effective than low-dose corticosteroids.
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Affiliation(s)
- Zahid Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | | | - Merve Ozturk Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Konul Mursel
- Department of Obstetrics and Gynecology, Akay Hospital, Ankara, Turkey
| | - Recep Onur Karabacak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Bahreiny SS, Ahangarpour A, Amraei M, Mansouri Z, Pirsadeghi A, Kazemzadeh R, Javidan M, Karamali N, Bastani MN, Dabbagh MR. Autoimmune thyroid disorders and polycystic ovary syndrome: Tracing links through systematic review and meta-analysis. J Reprod Immunol 2024; 163:104215. [PMID: 38402811 DOI: 10.1016/j.jri.2024.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
Polycystic Ovary Syndrome (PCOS) and Autoimmune Thyroiditis (AIT) are two prevalent endocrine disorders affecting women, often coexisting within the same patient population. This meta-analysis aims to systematically assess and synthesize the existing body of literature to elucidate the intricate relationship between PCOS and AIT. A systematic literature search for relevant observational studies was conducted in electronic databases such as Web of Science, Google Scholar, PubMed, Cochrane, and Scopus until March 2023. All Statistical analyses were performed using CMA Software v3.7 in a random-effects network meta-analysis. In addition, sensitivity and meta-regression analyses were conducted to identify sources of Heterogeneity based on related risk factors. Our meta-analysis included eighteen studies with 3657 participants, which revealed significant differences between PCOS patients and control groups. In particular, a considerable association was detected between PCOS and the presence of AIT (OR = 2.38; 95% CI: 1.63-3.49; P< 0.001) and elevated levels of TSH (SMD = 0.24; 95% CI: 0.06-0.42; P= 0.01), anti-TPO (SMD = 0.36; 95% CI: 0.19-0.53; P< 0.001), anti-TG (SMD = 1.24; 95% CI: 0.37-2.10; P< 0.001), and other positive serum antibodies compared to the control groups. The findings from this meta-analysis may contribute to enhanced diagnostic strategies like complete thyroid function tests, more targeted interventions, and improved patient care for individuals presenting with both PCOS and AIT. Additionally, identifying commonalities between these conditions may pave the way for future research directions, guiding the development of novel therapeutic approaches that address the interconnected nature of PCOS and AIT.
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Affiliation(s)
- Seyed Sobhan Bahreiny
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Medical Basic Sciences Research Institute, Physiology Research Center, Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Akram Ahangarpour
- Medical Basic Sciences Research Institute, Physiology Research Center, Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Amraei
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Mansouri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; USERN Office, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Pirsadeghi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Kazemzadeh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Moslem Javidan
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Negin Karamali
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad-Navid Bastani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Medical Basic Sciences Research Institute, Physiology Research Center, Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Dabbagh
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
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Chen K, Sun W, He L, Dong W, Zhang D, Zhang T, Zhang H. Exploring the bidirectional relationship between metabolic syndrome and thyroid autoimmunity: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1325417. [PMID: 38567309 PMCID: PMC10985172 DOI: 10.3389/fendo.2024.1325417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Observational studies have reported a possible association between metabolic syndrome (MetS) and thyroid autoimmunity. Nevertheless, the relationship between thyroid autoimmunity and MetS remains unclear. The objective of this research was to assess the causal impact of MetS on thyroid autoimmunity through the utilization of Mendelian randomization (MR) methodology. Methods We performed bidirectional MR to elucidate the causal relationship between MetS and their components and thyroid autoimmunity (positivity of TPOAb). Single nucleotide polymorphisms (SNPs) of MetS and its components were obtained from the publicly available genetic variation summary database. The Thyroidomics Consortium conducted a genome-wide association analysis, which provided summary-level data pertaining to thyroid autoimmunity. The study included several statistical methods, including the inverse variance weighting method (IVW), weighted median, simple mode, weight mode, and MR-Egger methods, to assess the causal link. In addition, to ensure the stability of the results, a sensitivity analysis was conducted. Results IVW showed that MetS reduced the risk of developing thyroid autoimmunity (OR = 0.717, 95% CI = 0.584 - 0.88, P = 1.48E-03). The investigation into the causative association between components of MetS and thyroid autoimmune revealed a statistically significant link between triglycerides levels and the presence of thyroid autoimmunity (IVW analysis, OR = 0.603, 95%CI = 0.45 -0.807, P = 6.82E-04). The reverse analysis did not reveal any causal relationship between thyroid autoimmunity and MetS, including its five components. Conclusions We have presented new genetic evidence demonstrating that MetS and its triglyceride components may serve as potential protective factors against thyroid autoimmunity.
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Affiliation(s)
| | | | | | | | | | | | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Abdolmohammadi-Vahid S, Samaie V, Hashemi H, Mehdizadeh A, Dolati S, Ghodrati-Khakestar F, Niafar M, Yousefi M. Anti-thyroid antibodies and underlying generalized immunologic aberrations in patients with reproductive failures. J Reprod Immunol 2022; 154:103759. [PMID: 36332368 DOI: 10.1016/j.jri.2022.103759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
The link between autoimmune thyroid diseases and reproductive failures, including implantation failure and pregnancy loss, has been attracted a great deal of attention in the last two decades. In this regard, a considerable progress has been achieved in understanding the etiopathogenesis of the adverse pregnancy consequences related to the presence of anti-thyroid antibodies, however, the exact action mechanisms of these antibodies are not fully comprehended. Thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs) and TSH receptor antibodies (TRAbs) are the anti-thyroid antibodies which are present in autoimmune thyroid disorder (AITD) patients, such as Hashimoto's thyroiditis. In this condition, the thyroid hormones production, which are essential for normal implantation and pregnancy, are disrupted, and compromise the embryo or fetus development. In addition, a hypothesis suggests that there is underlying generalized immune abnormalities behind the presence of these antibodies. On the other hand, similar immunologic aberrations have been observed in thyroid autoimmunity and reproductive complications, which are postulated to be the proper answer for the scientists who seek for the pathophysiology behind the presence of these antibodies. Elevated inflammatory responses and decreased immunoregulatory actions, seem to be the main interfering pathologic factors in maternal tolerance toward fetus. In addition, cross reactivity of these antibodies with antigenic determinants of egg, embryo and placenta is another suggested mechanism, causing implantation and pregnancy complications. The ability of anti-thyroid antibodies in passing through the placental barrier and affecting the fetal thyroid gland, makes them more threatening for maintenance of a pregnancy.
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Affiliation(s)
- Samaneh Abdolmohammadi-Vahid
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vajihe Samaie
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Huriyeh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Amir Mehdizadeh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mitra Niafar
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Association of Subclinical Hypothyroidism with Present and Absent Anti-Thyroid Antibodies with PCOS Phenotypes and Metabolic Profile. J Clin Med 2022; 11:jcm11061547. [PMID: 35329880 PMCID: PMC8948753 DOI: 10.3390/jcm11061547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) and subclinical hypothyroidism (SCH) often coexist, but implications of the co-occurrence of two disorders have not yet been established. The objective is to conclude whether SCH with present or absent anti-thyroid antibodies (ATA) impacts on the PCOS phenotype and alters biochemical or clinical parameters. METHODS A retrospective cohort study was conducted in a tertiary reference center. Clinical and biochemical parameters of women with PCOS were analyzed. RESULTS A total of 367 women with PCOS were included in the study, 114 (31.1%) of whom were diagnosed with SCH and 16 (4.4%) with autoimmune thyroiditis (AIT). Among all parameters studied, the strongest relationship with SCH was confirmed for insulin resistance and dyslipidemia. SCH was an independent risk factor for insulin resistance. In SCH the additional presence of ATA did not exacerbate the metabolic disorders. There was no significant association of any PCOS phenotype with SCH, nor with the presence of circulating ATA. There was no significant difference in hormonal parameters and mFerriman-Gallwey scale score between women with PCOS with and without SCH. CONCLUSIONS SCH alters metabolic, but not hormonal, parameters in PCOS. The diagnosis of SCH does not exclude the diagnosis of PCOS. The potential effect of positive ATA was insignificant.
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Birke L, Baston-Büst DM, Kruessel JS, Fehm TN, Bielfeld AP. Can TSH level and premenstrual spotting constitute a non-invasive marker for the diagnosis of endometriosis? BMC Womens Health 2021; 21:336. [PMID: 34544404 PMCID: PMC8454006 DOI: 10.1186/s12905-021-01474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background To date, there is no reliable non-invasive marker for the early detection and diagnosis of endometriosis available possibly resulting in a delayed diagnosis and consequently an unnecessary long ordeal for the individual woman. Therefore, the primary objective of the current study was to evaluate whether the combination of a thyroid-stimulating hormone (TSH) level > 2.5 µlU/ml and premenstrual spotting could serve as non-invasive markers of endometriosis. A secondary objective was to determine whether typical symptoms of endometriosis like dysmenorrhea and/or dyspareunia could increase the diagnostic reliability. Methods We conducted a retrospective, case–control study with 167 female patients at the Department of OB/GYN and REI (UniKiD) of the medical center of the University of Düsseldorf, between January 2015 and December 2016. 107 women with surgically confirmed endometriosis were compared to 60 without endometriosis (controls). To evaluate the diagnostic accuracy, we considered sensitivity, specificity and predictive values. In order to assess the association between the non-invasive markers and endometriosis an odds ratio (OR) with a 95% confidence interval was calculated. Results In our cohort, diagnosis of endometriosis with non-invasive markers according to their sensitivity yielded the following ranking: increased TSH level, premenstrual spotting, combination of both previous parameters, addition of dysmenorrhea, addition of dyspareunia and combination of all parameters. Conclusion The existence of endometriosis should be taken into consideration when a patient suffers from thyroid dysfunction and premenstrual spotting. Apart from an increased TSH level, the presence of premenstrual spotting underlines the possible diagnosis of endometriosis with non-invasive markers and therefore, the patient´s history needs to be taken into account carefully. Trial registration The retrospective study was approved by the Ethics Committee of the medical faculty of the Heinrich-Heine University, Düsseldorf, Germany, Registration number Düsseldorf: 5371R (approved: April 04th, 2016). Since the design of the study was retrospective no written informed consent was necessary.
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Nørgård BM, Catalini L, Jølving LR, Larsen MD, Friedman S, Fedder J. The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases - A Review. Clin Epidemiol 2021; 13:477-500. [PMID: 34194244 PMCID: PMC8236837 DOI: 10.2147/clep.s310795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
Assisted reproductive technology (ART) treatments in women with underlying chronic diseases have become increasingly frequent. The objective of this review is to provide an overview of the literature examining the chance of having a live born child after ART in women with chronic diseases, compared to other women receiving ART. We focused on some of the most prevalent chronic diseases in women during their reproductive years, ie ulcerative colitis, Crohn's disease, rheumatoid arthritis, multiple sclerosis, epilepsy, hyperthyroidism, hypothyroidism, and diabetes mellitus. Secondly, we studied the chance of successful implantation. The literature search was performed in the database Pubmed.gov. including all studies published before October 2020. Title and abstracts of 58 papers were reviewed, 37 papers were excluded and other 8 studies were excluded after full-text evaluation. Only 13 papers were eligible for review. Results indicate that women with ulcerative colitis, Crohn's disease, rheumatoid arthritis, hyperthyroidism, and diabetes mellitus type 2 might have problems with low implantation rate or early embryo development during ART. On the contrary, the few studies on women with hypothyroidism, diabetes mellitus type 1, and epilepsy suggest an equivalent chance of a live birth compared to other women undergoing ART. A possible explanation behind these differences could reside in the disease-specific dysregulation of the innate or adaptive immune system. To our knowledge, this is the first review on ART in women with chronic diseases, and it has disclosed that the evidence in this area is indeed sparse. We encourage others to examine live birth after ART in women with chronic diseases.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laura Catalini
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Skrzyńska KJ, Zachurzok A, Gawlik AM. Metabolic and Hormonal Profile of Adolescent Girls With Polycystic Ovary Syndrome With Concomitant Autoimmune Thyroiditis. Front Endocrinol (Lausanne) 2021; 12:708910. [PMID: 34276569 PMCID: PMC8283692 DOI: 10.3389/fendo.2021.708910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Both polycystic ovary syndrome (PCOS) and autoimmune thyroiditis (AT) are considered to be among the most common endocrinopathies in young women, and they are classified as diseases that affect many processes in the human body. Their role in the development of metabolic disorders and diseases of the cardiovascular system in adult women is also emphasized. However, there are no data available to assess such risk in the teenage girl population. The aim of the study was to assess the hormonal and metabolic profile of adolescent girls with PCOS, additionally diagnosed with AT, as well as to identify possible risk factors for the coexistence of AT and PCOS. MATERIAL AND METHODS 80 euthyroidic PCOS patients were qualified for the study (chronological age 16.54 ± 1.00 years, BMI 24.60 ± 4.16 kg/m2). Eighteen girls diagnosed with AT were included in the study group and 62 girls without AT-in the control group. Each patient had biochemical and hormonal tests performed. Additionally, to diagnose AT, the level of antibodies against thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG), as well as the image of the thyroid gland on ultrasound examination, were taken into account. RESULTS Estradiol concentration was significantly higher in the study than in the control group (203.00 ± 217.00 vs. 152.00 ± 78.50 pmol/L, p=0.02). Higher DHEAS concentrations were also observed in the AT group compared with the group without AT (391.28 ± 176.40 vs. 317.93 ± 114.27 µg/dl, p=0.04). Moreover, there was a positive correlation between AT and estradiol concentration (ry=0.27; p=0.04). It was also shown that there is a tendency toward statistical significance for the positive correlation between the positive anti-TPO titer and the glucose concentration at 120 min OGTT (rƴ=0.26; p=0.07) and girls with PCOS and AT had higher glucose levels in 120 min OGTT (115.29±41.70 vs. 98.56±28.02 mg/dl, p=0.08). CONCLUSION The study results showed no difference in the metabolic profile between the groups. The high concentration of estradiol found in girls with PCOS and AT may indicate the role of this hormone in the development of the autoimmune process. However, the numbers are small, and more research is needed to confirm our findings.
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Singh J, Wong H, Ahluwalia N, Go RM, Guerrero-Go MA. Metabolic, Hormonal, Immunologic, and Genetic Factors Associated With the Incidence of Thyroid Disorders in Polycystic Ovarian Syndrome Patients. Cureus 2020; 12:e11681. [PMID: 33391917 PMCID: PMC7769736 DOI: 10.7759/cureus.11681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022] Open
Abstract
Many endocrinopathies have been increasingly affecting females of reproductive age. Polycystic ovary syndrome (PCOS) and hypothyroidism are some of the most common endocrinopathies seen in females. The aim of this study is to find a relationship between the incidence of thyroiditis in polycystic ovarian syndrome patients. Literature review search was conducted via a series of systematic searches using multiple databases which lead to cross-referencing of articles within assigned criteria. Our study resulted in a review of 42 articles pertaining to our study. In this literature review article, factors were identified associating PCOS with thyroiditis. A viable relationship was found between the incidence of PCOS and thyroiditis. The combination of factors seen in this study proposes that clinicians may need to focus on certain markers regarding the screening of the incidence of thyroiditis. We also recommend future cohort studies to be conducted to further confirm the associations identified in this article.
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Affiliation(s)
- Jaya Singh
- Primary Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine and Research, Avalon University School of Medicine, Curcaco, CUW
| | - Hilda Wong
- Primary Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Primary Care, Avalon University School of Medicine, Curcaco, CUW
| | - Nancy Ahluwalia
- Primary Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Primary Care, Medical Univeristy of Silesia, Katowice, POL
| | - Ryan M Go
- Primary Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine and Surgery, University of Santo Tomas, Manila, PHL
| | - Michelle A Guerrero-Go
- Primary Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine and Surgery, University of Santo Tomas, Manila, PHL
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Tokgoz VY, Isim B, Tekin AB. The impact of thyroid autoantibodies on the cycle outcome and embryo quality in women undergoing intracytoplasmic sperm injection. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-00023-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
The influence of thyroid autoimmunity in in–vitro fertilization/intracytoplasmic sperm injection (ICSI) cycles is still a controversial issue. Although some women are euthyroid, some studies found thyroid dysfunction and thyroid autoimmunity increased the incidence of infertility. We aimed to evaluate the impact of anti-thyroid antibodies on the cycle parameters, embryo quality, and pregnancy outcomes in women who underwent ICSI cycles.
Results
Fertilization rate was significantly higher in anti-thyroid antibody-negative patients than in anti-thyroid antibody-positive patients (97.1 ± 10.5 vs. 91.5 ± 19.8, respectively, p = 0.003). Clinical pregnancy, miscarriage, and ongoing pregnancy rates were not different among study groups. The presence of top-quality embryo was lower in anti-thyroid antibody-positive patients but it did not reach any statistical significance (56.5% vs. 67.8%, p = 0.09). In the subgroup analysis, there were no significant differences except for the miscarriage rate according to the TSH threshold.
Conclusion
The clinical pregnancy and ongoing pregnancy were not affected by the positivity of anti-thyroid antibodies. We showed that thyroid autoimmunity may have an impact on fertilization rate and embryo quality in patients undergoing ICSI cycles. Miscarriage rate also increases with thyroid autoimmunity and TSH levels above 2.5 μIU/L.
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Zhang X, Lv X, Chen M, Liu H. Analysis of Blimp-1 and PD-1/PD-L1 Immune Checkpoint in an Autoimmune Thyroiditis Animal Model. Int J Endocrinol 2020; 2020:6543593. [PMID: 32351559 PMCID: PMC7178515 DOI: 10.1155/2020/6543593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE B lymphocyte-induced maturation protein 1 (Blimp-1) and programmed cell death protein 1 (PD-1) have opposing roles in the development of T cells; however, the mechanism of autoimmune thyroiditis- (AIT-) associated abortion is unclear. The present study investigated the expression of Blimp-1 and PD-1/PD-ligand 1 (PD-L1) in AIT-associated pregnancy loss and elucidated the related signaling pathway involving in the inflammatory response. METHODS An experimental fetal loss model with autoimmune thyroiditis was established after murine thyroglobulin- (mTg-) immunized CBA/J female mice mating with Balb/c males. ELISA was employed to investigate the TgAb level in the serum of CBA/J female mice. The expression of Blimp-1, PD-1/PD-L1, mammalian target protein rapamycin (mTOR), and Foxp3 proteins in the placenta and spleen was detected through immunofluorescence staining and western blotting. RESULTS ELISA indicated that the serum TgAb level in the mTg group was higher than that in the control group (P < 0.001). Fetal resorption rates increased in the mTg group compared with those in the control group (45.63% vs. 3.1%, P < 0.05). Blimp-1 levels in the placenta and spleen were higher in the AIT-related miscarriage group than in the control group. However, the expression of PD-1/PD-L1 and Foxp3 was significantly decreased in the placenta and spleen in the AIT-related miscarriage group. CONCLUSION Blimp-1 participates in the pathogenesis of autoimmune thyroid disease-associated pregnancy loss through the inflammatory immune response, which is potentially mediated through the PD-1/PD-L1 signaling pathway.
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Affiliation(s)
- Xue Zhang
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, China
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoshu Lv
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, China
| | - Mengya Chen
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, China
| | - Haixia Liu
- Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, China
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Jølving LR, Larsen MD, Fedder J, Friedman S, Nørgård BM. The chance of a live birth after assisted reproduction in women with thyroid disorders. Clin Epidemiol 2019; 11:683-694. [PMID: 31496823 PMCID: PMC6693421 DOI: 10.2147/clep.s208574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/31/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Women with thyroid disorders may have increased infertility and poor reproductive outcomes, but it is unclear if assisted reproductive technology (ART) is effective in this population. The aim of this study was to examine the chance of a pregnancy (biochemical and clinical), and a live birth after ART, in women with thyroid disorders undergoing ART treatment, compared to women without thyroid disorders. Among live-born children, we assessed the risk of congenital malformations. PATIENTS AND METHODS In a nationwide cohort study of all women undergoing ART treatments in Denmark from 1 January 1994 throughout June 2017, we calculated the chance of a pregnancy and a live birth after embryo transfer. Women with thyroid disorders were stratified into two groups: those diagnosed with hypothyroid or hyperthyroid disorders. The adjusted OR (aOR) of a biochemical and a clinical pregnancy, a live born child and a congenital malformation was computed using multilevel logistic regression models. RESULTS In total, 199,674 embryo transfers were included in 2,101 women with thyroid disorders and in 65,526 women without thyroid disorders. The chance of a biochemical pregnancy was significantly reduced in women with hyperthyroidism (aOR=0.80, 95% CI 0.69-0.93), and the aOR of a live birth was 0.86, 95% CI 0.76-0.98. The aOR for a live birth in women with hypothyroidism was 1.03 (95% CI 0.94-1.12). Children of women with hypothyroidism, who were conceived after ART treatment, had a significantly increased risk of any congenital malformation (aOR=1.46 [95% CI 1.07-2.00]). CONCLUSION Women with hyperthyroidism receiving ART treatment had a decreased chance of a live birth per embryo transfer compared to women without thyroid disorders. Women with hypothyroidism did not have a decreased chance of a live birth but their offspring had an increased risk of congenital malformation.
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Affiliation(s)
- Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Department D, Odense University Hospital, Odense, Denmark
- Research Unit of Human Reproduction, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy Research, Harvard Medical School, Boston, MA, USA
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy Research, Harvard Medical School, Boston, MA, USA
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Akhtar MA, Agrawal R, Brown J, Sajjad Y, Craciunas L. Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism. Cochrane Database Syst Rev 2019; 6:CD011009. [PMID: 31236916 PMCID: PMC6591496 DOI: 10.1002/14651858.cd011009.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thyroid disease is the second most common endocrine disorder affecting women of reproductive age. Subclinical hypothyroidism is diagnosed by an elevated thyroid-stimulating hormone concentration with a normal concentration of free thyroxine hormone. Autoimmune thyroid disease (ATD) is diagnosed by the presence of thyroid autoantibodies, regardless of thyroid hormone levels. Thyroxine may be a useful treatment for subfertile women with these two specific types of thyroid disease for improving pregnancy outcomes during assisted reproduction. OBJECTIVES To evaluate the efficacy and harms of levothyroxine replacement in subfertile women with subclinical hypothyroidism or with normal thyroid function and thyroid autoimmunity (euthyroid autoimmune thyroid disease, or euthyroid ATD) undergoing assisted reproduction. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers together with reference checking and contact with study authors and experts in the field to identify studies. We searched for all published and unpublished randomised controlled trials (RCTs) comparing thyroxine with no treatment or placebo, without language restrictions, from inception to 8 April 2019, and in consultation with the Cochrane CGF Information Specialist. SELECTION CRITERIA We included women undergoing assisted reproduction treatment, meaning both in vitro fertilisation and intracytoplasmic sperm injection, with a history of subfertility and with subclinical hypothyroidism or with euthyroid ATD. We excluded women with a previously known clinical hypothyroidism or already taking thyroxine or tri-iodothyronine. RCTs compared thyroxine (levothyroxine) with either placebo or no treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary review outcomes were live birth and adverse events of thyroxine; our secondary outcomes were clinical pregnancy, multiple pregnancy and miscarriage. MAIN RESULTS The review included four studies with 820 women. The included studies were of overall low risk of bias. Using GRADE methodology, we assessed the quality of evidence for the primary outcomes of this review to be very low- to low-quality evidence. Evidence was downgraded for imprecision as it was based on single, small trials with wide confidence intervals (CI). We were able to include data from three of the four included studies.In one study of women with both subclinical hypothyroidism and positive or negative anti-TPO antibodies (autoimmune disease), the evidence suggested that thyroxine replacement may have improved live birth rate (RR 2.13, 95% CI 1.07 to 4.21; 1 RCT, n = 64; low-quality evidence) and it may have led to similar miscarriage rates (RR 0.11, 95% CI 0.01 to 1.98; 1 RCT, n = 64; low-quality evidence). The evidence suggested that women with both subclinical hypothyroidism and positive or negative anti-TPO antibodies would have a 25% chance of a live birth with placebo or no treatment, and that the chance of a live birth in these women using thyroxine would be between 27% and 100%.In women with normal thyroid function and thyroid autoimmunity (euthyroid ATD), treatment with thyroxine replacement compared with placebo or no treatment may have led to similar live birth rates (risk ratio (RR) 1.04, 95% CI 0.83 to 1.29; 2 RCTs, number of participants (n) = 686; I2 = 46%; low-quality evidence) and miscarriage rates (RR 0.83, 95% CI 0.47 to 1.46, 2 RCTs, n = 686, I2 = 0%; low-quality evidence). The evidence suggested that women with normal thyroid function and thyroid autoimmunity would have a 31% chance of a live birth with placebo or no treatment, and that the chance of a live birth in these women using thyroxine would be between 26% and 40%.Adverse events were rarely reported. One RCT reported 0/32 in the thyroxine replacement group and 1/32 preterm births in the control group in women diagnosed with subclinical hypothyroidism and positive or negative anti-TPO antibodies. One RCT reported 21/300 preterm births in the thyroxine replacement group and 19/300 preterm births in the control group in women diagnosed with positive anti-TPO antibodies. None of the RCTs reported on other maternal pregnancy complications, foetal complications or adverse effects of thyroxine. AUTHORS' CONCLUSIONS We could draw no clear conclusions in this systematic review due to the very low to low quality of the evidence reported.
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Affiliation(s)
- M Ahsan Akhtar
- St Mary's HospitalReproductive MedicineHathersage RoadManchesterUKM13 0JH
| | - Rina Agrawal
- University Hospitals Coventry and Warwickshire NHS TrustDepartment of Obstetrics and GynaecologyCoventryUKCV2 2DX
- University of WarwickCoventryUKCV4 7AL
| | - Julie Brown
- The University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1142
| | - Yasmin Sajjad
- IVF Department. Burjeel hospital. Abu Dhabi. UAEDepartment of Obstetrics, Gynaecology and Reproductive MedicineNajda StreetAbu DhabiUnited Arab Emirates
| | - Laurentiu Craciunas
- University of BirminghamTommy’s National Centre for Miscarriage Research, Institute of Metabolism and Systems ResearchBirminghamUKB15 2TG
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Sawicka-Gutaj N, Ruchala M, Feldt-Rasmussen U, Rasmussen ÅK, Hegedüs L, Bonnema SJ, Groenvold M, Bjorner JB, Watt T. Patients with Benign Thyroid Diseases Experience an Impaired Sex Life. Thyroid 2018; 28:1261-1269. [PMID: 30039748 DOI: 10.1089/thy.2017.0602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study aimed to characterize the frequency of self-reported thyroid-related impaired sex life in patients with thyroid diseases, to examine its clinical correlates and relationship with overall quality of life (QOL), and to investigate the effect of treatment. PATIENTS AND METHODS Two separate patient samples with benign thyroid diseases were investigated: a cross-sectional sample (759 women and 118 men) treated at two Danish university hospital outpatient clinics, in 2007-2008, and a longitudinal sample (358 women and 74 men) undergoing treatment at the abovementioned centers, during 2008-2012, evaluated before and 6 months after therapy. The thyroid-specific QOL questionnaire ThyPRO was used to measure patient-evaluated thyroid-related sex life impairment. Biochemical and clinical variables were analyzed (i.e., age, education, degree of thyroid dysfunction, comorbidity, serum thyrotropin, total thyroxine, and triiodothyronine, as well as thyroperoxidase and thyrotropin receptor antibody concentrations). The SF-36 Health Survey was used to analyze the effect of impaired sex life on overall QOL. RESULTS In the cross-sectional sample, 36% of women and 31% of men reported what they perceived to be thyroid-attributable impaired sex life. Women with autoimmune thyroid diseases reported more impairment than those with non-autoimmune thyroid diseases. In patients with Graves' disease lower levels of educational attainment and in patients with toxic nodular goiter comorbidities were associated with impaired sex life. Overall QOL was lower in patients with thyroid-related sex life impairment. In the longitudinal sample, 42% of women and 33% of men had impaired sex life at baseline, which improved at 6 months follow-up only in women and, when analyzing individual diagnoses separately, statistically significantly among those with autoimmune hypothyroidism. Sexual impairment was associated with low education in patients with toxic nodular goiter and with high plasma triiodothyronine concentrations in patients with Graves' disease. In autoimmune hypothyroidism, a younger age was associated with sex life impairment. CONCLUSION We found a high frequency of self-reported, thyroid-related sex life impairment in patients with benign thyroid diseases, especially in young women with autoimmune thyroid diseases. Self-perceived impaired sex life persisted in women treated for Graves' disease, suggesting that normalization of thyroid function was not sufficient to restore sexual function.
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Affiliation(s)
- Nadia Sawicka-Gutaj
- 1 Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences , Poznan, Poland
| | - Marek Ruchala
- 1 Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences , Poznan, Poland
| | - Ulla Feldt-Rasmussen
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
| | - Laszlo Hegedüs
- 3 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Steen Joop Bonnema
- 3 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Mogens Groenvold
- 4 Department of Public Health, University of Copenhagen , Copenhagen, Denmark
| | - Jakob Bue Bjorner
- 4 Department of Public Health, University of Copenhagen , Copenhagen, Denmark
- 5 Optum Patient Insights , Johnston, Rhode Island
| | - Torquil Watt
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
- 6 Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte , Herlev, Denmark
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Andrisani A, Sabbadin C, Marin L, Ragazzi E, Dessole F, Armanini D, Donà G, Bordin L, Ambrosini G. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecol Endocrinol 2018; 34:752-755. [PMID: 29463152 DOI: 10.1080/09513590.2018.1442427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The influence of thyroid autoimmunity in assisted reproductive technology (ART) outcome in euthyroid women is still controversial. In this study, we retrospectively evaluated embryo quality in 123 euthyroid women undergoing ART with or without thyroid autoantibodies (TAA). Embryo quality was assessed in 119 embryos of 29 infertile patients with TAA and in 394 embryos of 94 infertile patients without TAA. Our results showed not statistically significant differences in age, body mass index, anti-Müllerian hormone, follicle stimulating hormone, free triiodothyronine, and free thyroxine levels between cases and controls. Thyroid stimulating hormone was within the normal range, but significantly higher in TAA patients compared with the controls (2.4 ± 0.8 vs. 2 ± 0.9 mIU/L, respectively, p < .01). The number of oocytes picked up and fertilized was comparable between the two groups. Embryo quality was significantly impaired in women with at least one autoantibody (p < .001). Implantation rate, pregnancy rate, and ongoing pregnancy rate were comparable in the two groups. These results suggest a negative impact of thyroid autoimmunity in embryo quality in women undergoing ART even when thyroid function is normal.
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Affiliation(s)
- A Andrisani
- a Department of Women's and Children's Health , Salus Pueri, University of Padua , Padua , Italy
| | - C Sabbadin
- b Department of Medicine (DIMED), Endocrinology Unit , University of Padua , Padua , Italy
| | - L Marin
- a Department of Women's and Children's Health , Salus Pueri, University of Padua , Padua , Italy
| | - E Ragazzi
- c Department of Pharmaceutical and Pharmacological Sciences , University of Padua , Padua , Italy
| | - F Dessole
- d Department of Surgical, Microsurgical and Medical Sciences, Gynecologic and Obstetric Clinic , University of Sassari , Sassari , Italy
| | - D Armanini
- b Department of Medicine (DIMED), Endocrinology Unit , University of Padua , Padua , Italy
| | - G Donà
- e Department of Molecular Medicine , Biological Chemistry, University of Padua , Padua , Italy
| | - L Bordin
- e Department of Molecular Medicine , Biological Chemistry, University of Padua , Padua , Italy
| | - G Ambrosini
- a Department of Women's and Children's Health , Salus Pueri, University of Padua , Padua , Italy
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Alonso-Cerezo MC, Calero Ruiz M, Chantada-Abal V, de la Fuente-Hernández LA, García-Cobaleda I, García-Ochoa C, García-Sagredo JM, Nuñez R, Oliva R, Orera-Clemente M, Pintado-Vera D, Sanchez-Ramon S. Recommendations regarding the genetic and immunological study of reproductive dysfunction. Med Clin (Barc) 2018; 151:161.e1-161.e12. [PMID: 29680457 DOI: 10.1016/j.medcli.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/13/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
In this article several members of diverse scientific associations and reproduction experts from Spain have updated different genetic and immunological procedure recommendations in couples affected by reproductive dysfunction with the goal of providing a set of useful guidelines for the clinic. The laboratory test has been considered as highly recommendable for making clinical decisions when the result of the diagnostic test is relevant, moderately recommendable when the results are of limited evidence because they are inconsistent, and low when the benefit of the test is uncertain. It is expected that these recommendations will provide some useful guidelines for the diagnosis, prognosis and treatment of couples presenting reproductive dysfunction.
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Affiliation(s)
- María Concepción Alonso-Cerezo
- Asociación Española de Biopatología Médica-Medicina de Laboratorio, Madrid, España; Genética Clínica, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, España
| | - Mercedes Calero Ruiz
- Asociación Española del Laboratorio Clínico, Madrid, España; UGC Intercentros Laboratorio Clínicos, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Venancio Chantada-Abal
- Asociación Española de Urología, Madrid, España; Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | | | - Inmaculada García-Cobaleda
- Sociedad Española de Medicina de Laboratorio, Barcelona, España; Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | | | | | - Rocío Nuñez
- Unidad de Reproducción, Clínica Tambre, Madrid, España
| | - Rafael Oliva
- Asociación Española de Andrología, Córdoba, España; Unidad de Genética, Departamento de Biomedicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Servicio de Genética y Biología Molecular, Hospital Clínico de Barcelona, Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - María Orera-Clemente
- Asociación Española de Genética Humana, Madrid, España; Hospital General Universitario Gregorio Marañón, Madrid, España
| | - David Pintado-Vera
- Sociedad Española de Ginecología y Obstetricia, Madrid, España; Sección de Esterilidad e Infertilidad, Hospital Quirón, Pamplona, España
| | - Silvia Sanchez-Ramon
- Sociedad Española de Inmunología, Barcelona, España; Servicio de Inmunología, Hospital Clínico Universitario San Carlos, Madrid, España
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Ippolito AC, Seelig AD, Powell TM, Conlin AMS, Crum-Cianflone NF, Lemus H, Sevick CJ, LeardMann CA. Risk Factors Associated with Miscarriage and Impaired Fecundity among United States Servicewomen during the Recent Conflicts in Iraq and Afghanistan. Womens Health Issues 2017; 27:356-365. [DOI: 10.1016/j.whi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023]
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Abstract
Autoimmune thyroid diseases (AIT) are common in children and may present with a variety of signs and symptoms including: euthyroid goiter, hypothyroidism, or hyperthyroidism. The natural history of AIT may be different in children but in all age groups, there appear to be genetic risk factors and environmental triggers that initiate thyroid autoimmunity. Areas covered: In this review, we summarize recent studies that investigate the genetics and environmental triggers believed to be involved in thyroid autoimmunity. We also discuss the approach and controversies in the treatment of children with AIT. Expert commentary: Much has been learned about the major roles for genetics, cytokines, regulatory lymphocytes, and environmental triggers in CLT but controversies remain.
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Affiliation(s)
- Prasanthi Pasala
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
| | - Gary L Francis
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
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Menon M, Ramachandran V. Antithyroid Peroxidase Antibodies in Women with Polycystic Ovary Syndrome. J Obstet Gynaecol India 2016; 67:61-65. [PMID: 28242970 DOI: 10.1007/s13224-016-0914-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/07/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To find the prevalence of thyroid autoimmunity in PCOS women of reproductive age group. METHODS Study design: Observational study was done at ESIMC and PGIMSR K.K. Nagar March 2013-Feb 2014. Ninety cases of women with PCOS based on Rotterdam's criteria and an equal number of age-matched controls (women without PCOS) were included in the study. Thyroid profile, antithyroid peroxidase titre, serum progesterone, testosterone and fasting blood sugar were estimated using standardised techniques. RESULTS Menstrual irregularity (oligomenorrhoea and amenorrhoea) was the most common abnormality found in patients with PCOS compared with non-PCOS (p < 0.0001). Hyperandrogenism was the second most common manifestation present in PCOS of our study group. Hirsutism was the striking hyperandrogenic feature that was present in study group. PCOS patients had higher BMI compared to controls (p < 0.0001). The prevalence of thyroid dysfunction was not significantly different in both the groups (p < 0.80). Anti-TPO titre was higher in PCOS patients (25.8 ± 2.9 IU/ml) compared to the controls (14.5 ± 2.3 IU/ml) (p < 0.009). CONCLUSION The present study shows that PCOS was associated with increased anti-TPO titres, thus emphasising the importance of screening all PCOS patients for anti-TPO along with routine thyroid profile.
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Affiliation(s)
- Maya Menon
- Department of Obstetrics and Gynaecology, ESIC Medical College and PGIMSR, Chennai, 600078 India
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20
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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; 9:18-22. [PMID: 27110073 PMCID: PMC4817282 DOI: 10.4103/0974-1208.178636] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/10/2015] [Accepted: 01/08/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a metabolic syndrome, characterized by anovulation, hyperandrogenism, and polycystic ovary. With serological markers of autoimmunity found elevated in PCOS, there is a possible link between autoimmunity and PCOS. AIM The study aimed to investigate the possible correlation between autoimmune markers of autoimmune thyroiditis (AIT) and PCOS. SETTING AND DESIGN This case control study was conducted at the Department of Pathology of a tertiary care academic center during a 1-year period. MATERIALS AND METHODS Fifty-five subjects with clinical PCOS and 51 age matched control non-PCOS subjects were recruited and subjected to clinical, biochemical, and endocrinal evaluation for AIT. All subjects underwent blood glucose and serum sampling for luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, dehydroepi androsterone, thyroxine, thyroid stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin (Tg), and insulin. STATISTICAL ANALYSIS Statistical analysis was performed using SPSS version 12 for Windows. The quantitative variables are described as mean ± standard deviation. To compare quantitative variables between two groups, unpaired t-test was used. The Chi-square/Fischer's exact test was used to compare qualitative variables. ANOVA was used to compare the PCOS and non-PCOS groups. P < 0.05 was considered significant. RESULTS Significantly higher prevalence of AIT (anti-Tg antibodies) was noted in subjects with PCOS as compared to non-PCOS control subjects (P < 0.05). The PCOS subjects had higher insulin resistance index and also twice the level of LH: FSH ratio as compared to controls. CONCLUSION Higher prevalence of AIT in PCOS subjects suggest possible role of autoimmune phenomenon in the etiopathogenesis of PCOS. More data from longitudinal follow-up studies is required to clearly establish this possible link.
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Affiliation(s)
- Sheetal Arora
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kiran Sinha
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sachin Kolte
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Mandal
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecol Endocrinol 2016; 32:306-10. [PMID: 26608409 DOI: 10.3109/09513590.2015.1116510] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM We aimed to investigate the ovarian function and reserve in euthyroid adolescents (TSH < 2.5 mIU/L) diagnosed with Hashimoto thyroiditis (HT). METHODS This case-control study included 30 adolescent girls (mean age 15.1 ± 1.4 years) newly diagnosed as HT with presence of high thyroid antibodies with gland heterogeneity in ultrasound and age-matched 30 healthy female subjects. Anti-ovarian antibody (AOAb), LH/FSH ratio, estradiol, anti-mullerian hormone (AMH), inhibin-B, total testosterone, antral follicle count, ovarian volumes and uterine length were measured. The clinical, laboratory, and ultrasound data of the HT and control groups were compared. RESULTS There were no significant differences between the girls with HT and healthy controls in relation to LH/FSH ratio, estradiol and inhibin-B levels. AOAb (p = 0.02), AMH (p = 0.007) and total testosterone levels were higher in HT group than the control group (p = 0.03). AOAb level was found to be positively correlated with LH/FSH ratio (p = 0.03), AMH (p = 0.01) and inhibin-B (p < 0.001) in HT group. CONCLUSION This study demonstrated that the adolescent girls diagnosed with autoimmune thyroiditis had normal ovarian reserve based on measurements of AMH, inhibin B, FSH, LH/FSH ratio, estradiol and antral follicle counts.
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Affiliation(s)
- Ozgur Pirgon
- a Department of Pediatric Endocrinology and Diabetes
| | | | - Hakan Demirtas
- b Department of Pediatric Radiology, Faculty of Medicine , S. Demirel University , Isparta , Turkey , and
| | - Bumin Dundar
- c Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine , Katip Celebi University , Izmir , Turkey
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Heng BC, Huang W, Zhong X, Yin P, Tong GQ. Roles of Antiphospholipid Antibodies, Antithyroid Antibodies and Antisperm Antibodies in Female Reproductive Health. ACTA ACUST UNITED AC 2015. [DOI: 10.1159/000381900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Yoshioka W, Amino N, Ide A, Kang S, Kudo T, Nishihara E, Ito M, Nakamura H, Miyauchi A. Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility. Endocr J 2015; 62:87-92. [PMID: 25312747 DOI: 10.1507/endocrj.ej14-0300] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infertile women sometimes associated with subclinical hypothyroidism (SCH). The guidelines of the American Endocrine Society, and American Association of Clinical Endocrinologists and American Thyroid Association recommend treatment with thyroxine (T4) for patients with SCH who want to have children. We examined 69 female infertile patients with SCH and the effects of levothyroxine (l-T4) therapy on pregnancy rates and pregnancy outcomes were observed. Fifty-eight (84.1%) patients successfully conceived during the T4 treatment period (Group A), although 17 patients (29.3%) had miscarriage afterward. The remaining 11 patients continued to be infertile (Group B). The median TSH value in Group A before the T4 treatment was 5.46 μIU/mL (range 3.1-13.3) and this significantly decreased to 1.25 μIU/mL (range 0.02-3.75) during the treatment (p<0.001). The estimated duration of infertility before the T4 treatment was 2.8±1.7 years and the duration until pregnancy after the treatment was significantly shorter at 0.9±0.9 years (p<0.001). Shortening of the infertile period after the T4 therapy was observed not only in patients who were treated with assisted reproductive technology (ART) but also in patients who conceived spontaneously in Group A. Administered T4 dose was 54.3±14.2 μg before pregnancy and 68.5±22.8 μg during pregnancy (p<0.001). Anti-thyroid autoantibodies were identified in 42.0% of all patients and no significant difference was observed in positivity between Group A and Group B. High successful pregnancy rate and shorter duration of infertility until pregnancy after T4 treatment strongly suggest that T4 enhanced fertility in infertile patients with SCH.
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Affiliation(s)
- Waka Yoshioka
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
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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:e17954. [PMID: 25237328 PMCID: PMC4166006 DOI: 10.5812/ijem.17954] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/24/2014] [Accepted: 05/04/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women in reproductive age. In many cases, PCOS is associated with infertility and increased risk of miscarriage. Recent studies have detected the presence of several organ specific and nonspecific autoantibodies in women with PCOS. OBJECTIVES The aim of this study was to evaluate the prevalence and levels of thyroid antibodies in euthyroid women with PCOS in Syria. PATIENTS AND METHODS This study included 56 euthyroid women with PCOS and 30 healthy women as a control group. PCOS was defined according to the revised 2003 Rotterdam criteria. Thyroid function was evaluated by measurement of serum TSH and FT4 levels. Antithyroid peroxidase and antithyroglobulin antibodies (anti-TPO and anti-TG, respectively) were detected as markers for thyroid autoimmunity. All parameters were measured using electrochemiluminescence immunoassay. RESULTS Women with PCOS had higher serum levels of anti-TPO in comparison to controls (39.9 ± 59.5 and 18.9 ± 11.2 IU/mL, respectively; P < 0.05) and no significant difference was found in serum levels of anti-TG, TSH, or FT4 between the two groups. Patients with PCOS had a higher prevalence of positive results for anti-TG and/or anti-TPO in comparison to controls (28.6% and 3.3%, respectively; P<0.05), anti-TPO alone (19.6% and 3.3%, respectively; P < 0.05) and anti-TG alone (21.4% and 3.3%, respectively; P < 0.05). No significant associations were found between antibodies and studied hormones. CONCLUSIONS High prevalence of thyroid antibodies in euthyroid patients with PCOS refers to the importance of investigation for thyroid autoimmune state in those patients.
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Affiliation(s)
- Raghad Al-Saab
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria
- Corresponding author: Raghad Al-Saab, Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria. Tel: +963-988419284, E-mail:
| | - Shaden Haddad
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria
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Akhtar MA, Owen DJ, Peitsidis P, Sajjad Y, Brown J, Agrawal R. Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism. Hippokratia 2014. [DOI: 10.1002/14651858.cd011009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Muhammad A Akhtar
- St Mary's Hospital; Reproductive Medicine; Hathersage Road Manchester UK M13 0JH
| | - David J Owen
- Liverpool Womens Hospital NHS Foundation Trust; Obstetrics and Gynaecology; Crown Street Liverpool UK L8 7SS
| | - Panagiotis Peitsidis
- Helena Venizelou Hospital; Obstetrics and Gynaecology; Helena Venizelou Square Athens Greece
| | - Yasmin Sajjad
- St Marys Hospital, Central Manchester University Hospital NHS Trust; Gynaecology; Oxford Road Manchester UK M13 9WL
| | - Julie Brown
- University of Auckland; The Liggins Institute and Department of Obstetrics and Gynaecology; FMHS Auckland New Zealand
| | - Rina Agrawal
- University Hospitals Coventry and Warwickshire NHS Trust; Department of Obstetrics and Gynaecology; Coventry UK CV2 2DX
- University of Warwick; Coventry UK CV4 7AL
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Koukkou E, Ilias I, Alexiou M, Mamali I, Nicopoulou S, Alevizaki M, Markou K. Urine selenium changes during pregnancy do not correlate with thyroid autoantibodies in a mildly iodine deficient population. Biol Trace Elem Res 2014; 157:9-13. [PMID: 24249585 DOI: 10.1007/s12011-013-9860-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/04/2013] [Indexed: 01/24/2023]
Abstract
Selenium (Se) is a key component of iodinases; higher Se levels are associated with lower titers of antithyroid peroxidase antibodies (anti-TPO). Pregnancy exerts profound effects on thyroid function and autoimmunity. To assess the relationship of urine Se levels with thyroid function and autoimmunity in pregnant women residing in Athens, Greece, we studied prospectively 47 euthyroid women in uncomplicated singleton pregnancies (mean age + SD: 30 + 5 years) in each trimester, measuring urine Se levels, urine iodine, plasma thyrotropin (TSH), free thyroxine and triiodothyronine (FT4 and FT3), as well as levels of anti-TPO antibodies. Changes of the measured parameters were assessed over each trimester; thyroid parameters were assessed with relation to Se levels. Urine Se dropped by the third trimester, whereas urine iodine did not change appreciably during pregnancy. TSH and anti-TPO did not show appreciable changes; FT4 and FT3 gradually decreased as the pregnancy advanced. No relationship between urine Se levels and anti-TPO was found. During pregnancy, changes in urine Se levels accompany mild changes in thyroid function. However, we did not find some association between these changes and thyroid autoimmune activity over this period, probably because the effect of Se on thyroid autoimmunity may only become apparent in case of excess Se fortification.
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Affiliation(s)
- E Koukkou
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, Greece,
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Strowitzki T. Infertilität bei Frauen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:1628-32. [DOI: 10.1007/s00103-013-1851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Toulis KA, Goulis DG, Tsolakidou K, Hilidis I, Fragkos M, Polyzos SA, Gerofotis A, Kita M, Bili H, Vavilis D, Daniilidis M, Tarlatzis BC, Papadimas I. Thyrotropin receptor autoantibodies and early miscarriages in patients with Hashimoto thyroiditis: a case-control study. Gynecol Endocrinol 2013; 29:793-6. [PMID: 23741968 DOI: 10.3109/09513590.2013.801449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We have previously hypothesized that early miscarriage in women with Hashimoto thyroiditis might be the result of a cross-reactivity process, in which blocking autoantibodies against thyrotropin receptor (TSHr-Ab) antagonize hCG action on its receptor on the corpus luteum. To test this hypothesis from the clinical perspective, we investigated the presence of TSHr-Ab in Hashimoto thyroiditis patients with apparently unexplained, first-trimester recurrent miscarriages compared to that in Hashimoto thyroiditis patients with documented normal fertility. A total of 86 subjects (43 cases and 43 age-matched controls) were finally included in a case-control study. No difference in the prevalence of TSHr-Ab positivity was detected between cases and controls (Fisher's exact test, p value = 1.00). In patients with recurrent miscarriages, TSHr-Ab concentrations did not predict the number of miscarriages (univariate linear regression, p value = 0.08). These results were robust in sensitivity analyses, including only cases with full investigation or those with three or more miscarriages. We conclude that no role could be advocated for TSHr-Ab in the aetiology of recurrent miscarriages in women with Hashimoto thyroiditis.
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Affiliation(s)
- Konstantinos A Toulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki (AUTH), Greece.
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