scholarly journals 2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction

2020 ◽  
Vol 9 (6) ◽  
pp. 281-295
Author(s):  
Kris Poppe ◽  
Peter Bisschop ◽  
Laura Fugazzola ◽  
Gesthimani Minziori ◽  
David Unuane ◽  
...  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Embryo Quality ◽  
Thyroid Autoimmunity ◽  
Thyroid Disorders ◽  
Menstrual Disorders ◽  
Normal Thyroid Function ◽  
Increased Risk ◽  
Meta Analyses ◽  
Ovarian Syndrome ◽  
Serum Tsh

Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level <2.5 mIU/L. Subfertile women with hyperthyroidism planning an ART procedure should be informed of the increased risk of maternal and foetal complications, and euthyroidism should be restored and maintained for several months prior to an ART treatment. Fertilisation rates and embryo quality may be impaired in women with TSH >4.0 mIU/L and improved with LT4 therapy. In meta-analyses that mainly included women with TSH levels >4.0 mIU/L, LT4 treatment increased live birth rates, but that was not the case in 2 recent interventional studies in euthyroid women with TAI. The importance of the increased use of intracytoplasmic sperm injection as a type of ART on pregnancy outcomes in women with TAI deserves more investigation. For all of the above reasons, women of subfertile couples should be screened routinely for the presence of thyroid disorders.

scholarly journals Management of endocrine disease: Thyroid and Female Infertility:More Questions than Answers?!

2021 ◽  
Author(s):  
Kris Gustave Poppe
Keyword(s):  
Current Knowledge ◽  
Thyroid Autoimmunity ◽  
Treatment Options ◽  
Initial Step ◽  
Reproductive Organs ◽  
Thyroid Disorders ◽  
Endocrine Disease ◽  
Normal Thyroid Function ◽  
Serum Tsh

Severe thyroid dysfunction may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary-ovarian axis and the reproductive organs. However, the precise prevalence of infertility in women with thyroid disorders remains unknown. Fertility problems may persist even after restoring normal thyroid function, and then surgery and/or an assisted reproductive technology (ART) may be necessary to obtain a pregnancy. The initial step in an ART treatment is the ovarian stimulation, putting strain on the thyroid gland, potentially leading to (permanent) hypothyroidism in women with thyroid autoimmunity (TAI) or when already treated with thyroid hormones (LT4). Moreover, women with ovarian and unexplained causes of infertility have a higher prevalence of TAI. In women treated with LT4, a serum TSH level <2.5 mIU/L should be targeted before ART. In women with TSH levels >4.0 mIU/L, fertilisation rates, embryo quality and live birth rates may be impaired and improved with LT4 therapy. In euthyroid women with TAI, LT4 should not be given systematically, but on a case-by-case basis if serum TSH is >2.5 mIU/L. For all of the above reasons, women of infertile couples should be screened routinely for the presence of thyroid disorders. In this review, we will focus on the gaps in the current knowledge, the remaining questions on the associations between thyroid (disorders) and (assisted) reproduction and make proposals for future investigations that may lead to a better understanding and contribute to novel treatment options in the long term.

scholarly journals Subclinical Hypothyroidism in PCOS: Impact on Presentation, Insulin Resistance, and Cardiovascular Risk

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Qun Yu ◽  
Jin-Bei Wang
Keyword(s):  
Cardiovascular Risk ◽  
Subclinical Hypothyroidism ◽  
Polycystic Ovarian Syndrome ◽  
Normal Population ◽  
Statistical Significance ◽  
Cardiovascular Disorder ◽  
Control Subjects ◽  
Increased Risk ◽  
Pcos Group ◽  
Ovarian Syndrome

Aim of Study. To assess status of thyroid function and thyroid disorders particularly subclinical hypothyroidism (SCH) in subjects with polycystic ovarian syndrome (PCOS) and impact of SCH on various clinical and biochemical parameters and cardiovascular risk in PCOS.Methods. Hundred females diagnosed with PCOS as per Rotterdam criteria and 100 normal controls were recruited and were subjected to elaborate anthropometric, clinical, and biochemical assessment.Results. Notable findings included significantly higher frequency of subjects with subclinical hypothyroidism (p=0.0002), autoimmune thyroiditis (p<0.001), and goitre (p=0.02) in polycystic ovarian syndrome subjects compared to control subjects. Further SCH PCOS subjects were found to harbor significantly higher HOMA-IR (p<0.05) and frequency of subjects with dyslipidemia (p<0.05) compared to both euthyroid PCOS and euthyroid control subjects. Though frequency of subjects with cardiovascular risk factors was higher in SCH PCOS group than euthyroid PCOS group, it failed to reach statistical significance.Conclusion. We concluded that PCOS is associated with high incidence of SCH and AIT compared to normal population and SCH poses increased risk of cardiovascular disorder in PCOS.

scholarly journals Pregnancy Complications in Women with PCOS

2019 ◽  
Vol 3 (5) ◽  
Keyword(s):  
Pregnancy Loss ◽  
Polycystic Ovarian Syndrome ◽  
First Trimester ◽  
Reproductive Age ◽  
Multiple Pregnancies ◽  
Proper Understanding ◽  
Life Styles ◽  
Reproductive Age Women ◽  
Increased Risk ◽  
Ovarian Syndrome

The Polycystic ovarian syndrome affects 6-15 % of reproductive age women worldwide. And recently the changing life styles and rising obesity worldwide have contributed to a rise in the incidence of PCOS. Though there are many issues with PCOS post conception. PCOS women are at increased risk of early pregnancy loss which is approx. three fold as compared to the women without PCOS. After successfully crossing the first trimester, they are at risk of developing pre- eclampsia, GDM, preterm birth and birth of small for gestational age infant. Also higher incidence of multiple pregnancies is there and the risks associated with them. All these leading to higher rate of c -section delivery. So, proper understanding of these risks, informing and counseling the patients regarding them facilitate closer maternal and fetal surveillance and help improving the outcome of pregnancy.

scholarly journals Thyroid disorders in subfertility and early pregnancy

2020 ◽  
Vol 11 ◽  
pp. 204201882094585
Author(s):  
Samantha Anandappa ◽  
Mamta Joshi ◽  
Lukasz Polanski ◽  
Paul V. Carroll
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Current Knowledge ◽  
Thyroid Autoimmunity ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Increased Risk ◽  
Hormone Use ◽  
Current Knowledge Base ◽  
In Pregnancy

Disorders of thyroid function are common in pregnancy and have implications for foetal and maternal health. Thyroid autoimmunity, as evidenced by the presence of elevated levels of anti-thyroid antibodies (anti-TPO and anti-Tg antibodies) is associated with an increased risk of miscarriage, though the mechanism remains poorly understood. There has been considerable focus on the implications and optimal management of pregnant women with thyroid disease, especially those undergoing assisted reproduction. Pregnancy results in significant changes in thyroid physiology and these need to be understood by clinicians involved in the care of pregnant women. Guidelines for the use of thyroxine and target thyroid function tests have been produced by international bodies but it is recognised that these predominantly reflect expert opinion rather than established evidence-based practice. Importantly a number of key clinical trials have been performed to aid understanding, particularly of the consequences of hypothyroidism for mother and baby, and the effectiveness of thyroid hormone use in autoimmune and subclinical hypothyroidism. This review summarises the current knowledge base and guidance for practice relating to thyroid disorders in pregnancy and subfertility.

Association between depression risk and polycystic ovarian syndrome in young women: a retrospective nationwide population-based cohort study (1998–2013)

2019 ◽  
Vol 34 (9) ◽  
pp. 1830-1837 ◽  
Author(s):  
Tomor Harnod ◽  
Weishan Chen ◽  
Jen-Hung Wang ◽  
Shinn-Zong Lin ◽  
Dah-Ching Ding
Keyword(s):  
Clinical Trial ◽  
Cohort Study ◽  
Polycystic Ovarian Syndrome ◽  
Population Based ◽  
Aged Patients ◽  
Depression Risk ◽  
Increased Risk ◽  
History Of ◽  
Competing Interest ◽  
Ovarian Syndrome

Abstract STUDY QUESTION Is polycystic ovarian syndrome (PCOS) in women associated with the increasing incidence of depression in an East Asian population? SUMMARY ANSWER Younger PCOS patients (aged 15–29 years), but not middle-aged patients, have an increased risk of depression in Taiwan. WHAT IS KNOWN ALREADY During reproductive age, 6–10% of women have PCOS. Among them, ~40% experience depression, mostly at young ages. STUDY DESIGN, SIZE, DURATION This is a retrospective population-based cohort study analysing depression risk in Taiwanese women using data from a nationwide database containing 1998–2013 data of nearly 1 million people. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 15- to 50-year-old women newly diagnosed with PCOS during 1998–2013 from the Taiwan National Health Insurance Research Database as the PCOS cohort (n = 7684) and then randomly matched them 4 : 1 by sex, age and index year with women without PCOS as the comparison cohort (n = 30 736). We used multivariable Cox proportional hazard regression analysis to determine the association between PCOS and depression risk [hazard ratio (HR) with 95% confidence interval (CI)]. MAIN RESULTS AND THE ROLE OF CHANCE The incidence of depression was higher in the PCOS group than in the comparison group (6.67 vs. 4.82 per 1000 person-years; adjusted HR = 1.28, 95% CI = 1.12–1.46). PCOS patients aged 15–29 years had a significantly higher depression risk (adjusted HR = 1.39, 95% CI = 1.18–1.65); no such significant association was noted among patients aged 30–39 years and 40–50 years. LIMITATIONS, REASONS FOR CAUTION A history of malignancy, which may increase depression, could not be obtained for our study patients. Moreover, we could not obtain a family history of depression, a relevant risk factor for depression. Finally, the database has no records of body mass index, which may influence depression outcome. WIDER IMPLICATIONS OF THE FINDINGS In Taiwan, younger PCOS patients (15–29 years), but not the middle-aged patients, have an increased risk of depression. Our findings provide vital information to patients, clinicians, the Taiwan Government and other developing Asian countries to improve the PCOS treatment strategies in the future. Routine screening for depression in PCOS patients may be implemented into the health practice. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133 004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. No competing interest existed. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Reem A Al Khalifah ◽  
Ivan D Florez ◽  
Michael J Zoratti ◽  
Brittany Dennis ◽  
Lehana Thabane ◽  
...  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Treatment Options ◽  
Credible Interval ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Oral Contraceptive Pills ◽  
Moderate Quality ◽  
Meta Analyses ◽  
Ovarian Syndrome ◽  
Quality Evidence

Abstract Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considerable variation in health care practices. We aimed to compare the effects of metformin and/or oral contraceptive pills (OCP) in combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions among adolescents aged 11 to 19 years with PCOS. Literature searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through December 2018, with no language restriction. Two reviewers screened titles and abstracts, assessed full text eligibility, and extracted information from eligible trials. Evidence was synthesized through network meta-analyses (NMA) using a Bayesian random-effects approach. We identified 37 randomized controlled trials, in which 2400 patients were randomized. NMA showed no statistically important difference among all interventions to improve menstrual regulation or body mass index. Moderate-quality evidence showed hirsutism scores were reduced by multiple interventions that included single and combination medications namely; lifestyle intervention, metformin, OCP, spironolactone, pioglitazone, metformin-OCP, metformin-spironolactone, and metformin-flutamide against placebo. Moderate-quality evidence showed OCP results in more dysglycemia compared to metformin (odds ratio, 2.98; 95% credible interval, 1.02-8.96), no intervention resulted in dysglycemia reduction. In conclusion, metformin and OCP as monotherapy or in combination with other interventions compared with placebo can reduce hirsutism scores, but none of these medications lead to effective menstrual cycle regulation or weight reduction. However, the use of OCP leads to worse cardiometabolic risk factors. Further research into new treatment options is urgently needed. PROSPERO registration number CRD42015016148.

Risk of Thyroid Disorders in Patients with Gout and Hyperuricemia

2019 ◽  
Vol 51 (08) ◽  
pp. 522-530
Author(s):  
Jian Xu ◽  
Bin Wang ◽  
Qian Li ◽  
Qiuming Yao ◽  
Xi Jia ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Thyroid Autoimmunity ◽  
Cross Sectional Study ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Disorders ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk

AbstractThe risk of thyroid autoimmunity and thyroid dysfunction among patients with gout and hyperuricemia has not been well defined. This study was undertaken to examine the impact of gout and hyperuricemia on risk of thyroid disorders including thyroid autoimmunity and thyroid dysfunction. A population-based cross-sectional study was conducted to assess the risk of thyroid autoimmunity and thyroid dysfunction related to gout and hyperuricemia, which included 115 gout patients, 439 hyperuricemic patients, and 2 254 individuals without gout and hyperuricemia. A systematic review and meta-analysis of 14 observational studies was also done to systematically evaluate the risk of thyroid dysfunction among patients with gout and hyperuricemia. Findings from the cross-sectional study suggested a significantly increased risk of hypothyroidism among female gout patients (OR=2.44, 95% CI 1.15–5.17, p=0.02). Besides, gout could also substantially increase risk of Hashimoto’s thyroiditis in women (OR=3.15, 95% CI 1.53–6.49, p=0.002). The meta-analysis proved a considerably increased risk of hypothyroidism among both gout patients (OR=1.51, 95% CI 1.23–1.85, p<0.001) and hyperuricemic patients (OR=1.34, 95% CI 1.11–1.61, p=0.002). Moreover, this meta-analysis also suggested that gout could also significantly increase the risk of hyperthyroidism (OR=1.25, 95% CI 1.06–1.48, p=0.01). The findings from the study suggest increasing risk of hypothyroidism and Hashimoto’s thyroiditis among gout patients. Moreover, gout but not hyperuricemia is linked to increased risk of hyperthyroidism. More studies are warranted to elucidate the influence of gout and hyperuricemia on thyroid disorders.

Prevalence of hypothyroidism and thyroid autoimmunity in polycystic ovarian syndrome patients: A North Indian study

2019 ◽  
Vol 16 (2) ◽  
pp. 55 ◽  
Author(s):  
Deepak Khandelwal ◽  
Diksha Goyal ◽  
Pooja Relia ◽  
Angela Sehra ◽  
Deep Dutta ◽  
...  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Thyroid Autoimmunity ◽  
Indian Study ◽  
Ovarian Syndrome
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