Amirtha Jansirani, R (2015) A Study on Thyroid Function Status in Newly Diagnosed Polycystic Ovarian Syndrome Patients. Masters thesis, Madras Medical College, Chennai.
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Abstract
AIM AND OBJECTIVE: 1) To assess the Thyroid function status using serum TSH and estimate the prevalence of hypothyroidism in newly diagnosed PolyCystic Ovarian Syndrome patients. 2) To compare certain hormones and parameters between euthyroid and hypothyroid patients having Polycystic ovarian Syndrome. MATERIALS AND METHODOLOGY: In our study, we selected 73 post pubertal women who came with complaints of menstrual irregularities for a period of three months and /or infertility from Institute of Obstetrics & Gynaecology and medical Endocrinology clinic attached to Madras Medical College. With the ultrasound evidence of polycystic ovaries we proceeded the study. This study was approved by Institutional Ethic Committee. Study design: A cross sectional, observation study. Inclusion criteria : 1. Women aged between 15-35 yrs with menstrual irregularities or Infertility. 2. PCOS confirmation based on revised Rotterdam criteria 2003: (2 / 3 criteria should be satisfied) 1. History of oligomenorrhoea (cycle lasting more than 35 days) or long cycles /Amenorrhoea (no cycles in the past 6 months). 2. Clinical and / or Biochemical features of hyperandrogenism. 3. Ultra sonogram finding : Multiple cysts (> 12 in number of 1-2mm) either one or both ovaries. Other cause of hyperandrogenism like Congenital adrenal hyperplasia, Virilising tumor, Prolactinoma, Cushing syndrome should be ruled out. Clinical hyperandrogensm is defined as to have acne and / or hirsutism and / or androgenic pattern of alopecia. Biochemical hyperandrogenism was defined as elevated testosterone. Exclusion Criteria: 1. Patients on treatment for Hypothyroidism, Oral contraceptives, Anticonvulsants, Metformin. 2. Other conditions mimicking PCOS were ruled out by detailed history and complete physical examination. STATISTICAL ANALYSIS: Statistical analysis is done by SPSS software version 17. 1. Student t- test & Chi-square test were applied for comparing Age, BMI, WHR, FBS, PPBS, Ovarian volume, Testosterone, HOMA-IR between the two groups of PCOS patients (with Euthyroid and Hypothyroidism). 2. Pearson co-efficient correlation was applied for TSH & Testosterone, Total Testosterone & WHR. SUMMARY: A cross sectional study was conducted in 73 newly diagnosed Polycystic Ovarian Syndrome patients. Among 73 participants, 16 were diagnosed to have hypothyroidism based on serum TSH (Thyroid Stimulating hormone) level with the cut-off value of 5μU/mL. They were divided into 2 groups. Group: 1 PCOS women with euthyroidism. Group: 2 PCOS women with hypothyroidism. From our study, we found that: 1. Mean BMI, Waist / Hip ratio, Fasting Insulin, HOMA-IR, Testosterone among PCOS patients were found to be higher than the recommended reference range. 2. The prevalence of hypothyroidism in PCOS patients was (22%), which is higher than the prevalence of hypothyroidism in general reproductive age women (2-4%). Thus, prevalence studies helps to bring many submerged/occult disorders to light there by aiding in correct diagnosis and proper treatment. 3. Our study followed the American Thyroid guidelines recommendation of using serum TSH alone instead of the entire thyroid profile for screening hypothyroidism in adults outpatient department which may be cost effective and economical for the patients and the health care providers. 4. Comparison of mean Testosterone between euthyroid and hypothyroid patients shows that hypothyroidism poses an additional contributing factor in developing features of hyperandrogenism, subfertility, infertility and even ovarian failure. CONCLUSION Polycystic Ovarian Syndrome, an ill defined complex disorder and needs a keen attention while treating. As ethnicity plays a vital role in this disorder, the characteristics of this disorder in different population should be known. There exists a cycle in the pathogenesis of PCOS from hypothalamus to ovary and vise-versa. The ultimate finding is hyperandrogenism. Systemic disorders like Hypothyroidism, Hyperprolactinemia, Hyperinsuliemia also contributes to hyperandrogenism by reducing the hepatic SHBG production. All these factors lead to hormonal imbalance affecting ovarian homeostasis resulting in anovulation. The final outcome may be single or multiple,from simple acne to complicated infertility. Very often these PCOS women were found to have hypothyroidism remaining submerged / undiagnosed which augments the existing hyperandrogenism. Timely and appropriate investigations can halt this cyclical event and its progression by early diagnosis and treatment. From this study, it is concluded that: Hypothyroidism is definitely an important contributing factor for hyperandrogenism, hence screening for hypothyroidism along with reproductive hormone profile should be evaluated in PCOS / infertile women for early diagnosis and management.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Thyroid Function Status ; Newly Diagnosed ; Polycystic Ovarian Syndrome Patients. |
| Subjects: | MEDICAL > Biochemistry |
| Depositing User: | Punitha K |
| Date Deposited: | 06 May 2018 15:00 |
| Last Modified: | 06 May 2018 15:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7547 |
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