PCOS and Thyroid Disorders

The abnormalities in thyroid hormones can play a major role in developing PCOS, which is also often influenced by a condition called insulin resistance.

Updated: October 25, 2017

PCOD or PCOS is a complex condition that can be difficult to diagnose. As some PCOS and thyroid symptoms are similar or they might occur together ,it is sometimes mistaken for a thyroid disorder. The abnormalities in thyroid hormones can play a major role in developing PCOS, which is also often influenced by a condition called insulin resistance.

How Are PCOS and Thyroid Disorders Connected?

A woman with Polycystic Ovarian Syndrome (PCOS) have a greater risk for developing a thyroid disorder.  Hormonal imbalance is the root cause for both of these conditions,
The shared signs and symptoms include:

  •     No menstrual period, infrequent menses and/or irregular bleeding
  •     Infrequent or absent ovulation
  •     Increased levels of male hormones
  •     Infertility (number one symptom of PCOS)
  •     Cystic ovaries
  •     Enlarged ovaries
  •     Chronic pelvic pain
  •     Obesity or weight gain
  •     Excess body hair in unwanted places
  •     Baldness or thinning hair
  •     Insulin resistance (overproduction of insulin) and diabetes
  •     Abnormal lipid levels
  •     High blood pressue
  •     Acne/oily skin/seborrhea
  •     Depression or depression with anxiety

Thyroid disorders are much easier to diagnose than Polycystic Ovarian Syndrome (PCOS).

PCOS, Thyroid, and Insulin Resistance:

Insulin resistance is a major component of PCOS. Insulin resistance is caused by a variety of factors such as genetics, weight, diet, and lifestyle. Insulin is a hormone that helps muscle and fatty tissue to utilize glucose from the bloodstream and to store it as fat or energy. When the body tissues are resistant to insulin, the pancreas simply makes more insulin to compensate and to keep the blood sugar levels controlled. Therefore a woman with PCOS will often have much higher insulin levels in her blood than normal.
High insulin levels cause the pituitary gland to make too much luteinizing hormone (LH) which causes the overproduction of testosterone resulting in anovulation.
The high testosterone in PCOS sparks even more insulin resistance. The higher the insulin, the more severe hormonal dysregulations become. Also low thyroid function aggravates insulin resistance in PCOS.

PCOS TSH Levels and Subclinical Hypothyroidism:

Women with PCOS have higher TSH levels and are also more likely to have subclinical hypothyroidism when compared to women who doesn't have PCOS. Women with the higher TSH values tended to have the most severe insulin resistance.
Women with PCOS and those who had a higher TSH will have a higher BMI, higher fasting insulin levels, higher total testosterone, and decreased sex hormone-binding globulin concentrations in comparison with women with women having normal TSH level.

Sex Hormone Binding Globulin(SHBG), Thyroid and PCOS:

The levels of sex hormone binding globulin (SHBG) is also affected by changes in thyroid function. In PCOS, high levels of insulin lowers the level of SHBG, leaving androgenic hormones free to produce all the symptoms of PCOS. Thyroid hormones increase the levels of SHBG. When there is deficiency of thyroid hormones, androgenic symptoms occurs such as hair loss, acne, and hirsutism worse.

Ovarian Volume and Ovarian Cysts in Hypothyroidism:

Hypothyroidism causes the deposit of mucopolysaccharides within various organs. These materials when deposited in the ovaries create obstruction for ovary to function properly hamper hormone synthesis, resulting in irregular menstrual cycling. The follicles that have not ovulated, will undergone partial development resulting in cysts of PCOS. As such, the disruption of ovulation by hypothyroidism may also produce similar cysts.
However, thyroid hormone replacement therapy reduced the size of the ovaries and improve TSH, FT3 and FT4, prolactin, estradiol, free testosterone and total testosterone levels.
When thyroid function is restored, the polycystic ovary appearance completely disappears in all hypothyroid women and many of the women may have improved menstrual regularity.

Autoimmune Thyroiditis and PCOS:

Autoimmune thyroid disease is also known as Hashimoto’s thyroiditis.It is the leading cause of hypothyroidism in women of reproductive age which has a correlation with PCOS.
Women with PCOS will have a increase in thyroid peroxidase antibodies, and the incidence of goiter. Also  there will be an increased prevalence of autoimmune thyroiditis, increased serum TSH, increased anti TPO antibodies, and anti TG antibodies in women with PCOS when compared to control groups.
Autoimmune thyroid disease is associated with poor treatment response in infertile women who suffer from PCOS.

Thyroid health has a considerable impact on the pathology of PCOS, affecting all aspects of the disorder. Therefore, all women with PCOS should have their thyroids evaluated thoroughly which include testing the levels of TSH, FT3, FT4, Anti TPO, Anti TG.  Correcting subclinical hypothyroidism is key to improving overall hormonal and metabolic health.
Women with PCOS require thyroid hormone replacement therapies. But for those with mild thyroid hypofunction or Hashimoto's can benefit greatly from therapies such as adrenal support, thyroid specific nutritional supplements, and dietary changes to reduce autoimmunity.
Reversal of this disorder can be achieved by lifestyle change, a diet that lowers inflammation and insulin levels, and supplements/herbs that address hormone regulation.


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