Der Nuklearmediziner 2013; 36(04): 229-232
DOI: 10.1055/s-0033-1358757
Schilddrüsenerkrankungen und Stoffwechselstörungen, ­Schwangerschaft und Psyche
© Georg Thieme Verlag KG Stuttgart · New York

Schilddrüse und Polyzystisches Ovarsyndrom

Thyroid and Polycystic Ovary Syndrome
J. Ulrich
1   Asklepios Klinik St. Georg, Hamburg
,
D. Müller-Wieland
1   Asklepios Klinik St. Georg, Hamburg
,
C. Keck
2   Endokrinologikum Hamburg
,
O. E. Janssen
2   Endokrinologikum Hamburg
› Author Affiliations
Further Information

Publication History

Publication Date:
09 January 2014 (online)

Zusammenfassung

Das polyzystische Ovarsyndrom (PCOS) ist durch Hyperandrogenämie/Hyperandrogenismus, Zyklusstörung und polyzystische Ovarien charakterisiert. Mit einer Prävalenz von 5–8% ist es die wichtigste Ursache für einen unerfüllten Kinderwunsch. Darüber hinaus verursacht es erhebliche kosmetische Probleme (Hirsutismus, Akne, Alopezie). Durch seine Assoziation mit dem metabolischen Syndrom (MBS) stellt es ein ernstzunehmendes kardiovaskuläres Risiko dar. Außerdem ist das PCOS mit einer erhöhten Prävalenz der Hashimoto-Thyreoiditis assoziiert. PCOS und die mit einer Hashimoto-Thyreoiditis assoziierte Hypothyreose stellen unabhängig voneinander ein metabolisches, kardiovaskuläres und gynäkologisches Risiko dar, sodass bei PCOS-Patientinnen ein Schilddrüsenscreening (Schilddrüsensonografie, TSH- und TPO-Antikörper-Bestimmung) empfohlen wird. Höhere TSH-Werte bei Frauen mit PCOS und Hashimoto-Thyreoiditis sind mit einem erhöhten Körpergewicht und BMI assoziiert – möglicherweise kann hier eine Schilddrüsenhormonsubstitution zur Gewichtsabnahme beitragen.

Abstract

The polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia/hyperandrogenism, irregular menses and polycystic ovaries. With a prevalence of 5–8% it is the main cause of infertility. It also causes profound cosmetic problems (hirsutism, acne, alopecia). Through its association with the metabolic syndrome (MBS) it also represents a significant cardiovascular risk. Furthermore, PCOS is associated with an increased prevalence of autoimmune thyroiditis (AIT). PCOS and the hypothyroidism associated with AIT both pose a metabolic, cardiovascular and gynecological risk. Thus, PCOS patients should be screened for thyroid disorders by thyroid ultrasound and determination of TSH and TPO-antibody levels. Elevated TSH-values in PCOS patients with AIT correlate with an increased body weight and BMI – thyroid hormone replacement may thus be an option for weight reduction in these patients.

 
  • Literatur

  • 1 Azziz R, Carmina E, Dewailly D et al. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91: 456-488
  • 2 Barthel A, Keck C, Janssen OE et al. Schilddrüse und Schwangerschaft. Dtsch Med Wochenschr 2012; 137: 171-174
  • 3 Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29: 76-131
  • 4 Celik C, Abali R, Tasdemir N et al. Is subclinical hypothyroidism contributing dyslipidemia and insulin resistance in women with polycystic ovary syndrome?. Gynecol Endocrinol 2012; 28: 615-618
  • 5 Dahlgren E, Janson PO, Johansson S et al. Polycystic ovary syndrome and risk for myocardial infarction. Evaluated from a risk factor model based on a prospective population study of women. Acta Obstet Gynecol Scand 1992; 71: 599-604
  • 6 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497
  • 7 Führer D. Schilddrüsenerkrankungen in der Schwangerschaft. Internist 2011; 52: 1158-1166
  • 8 Ganie MA, Marwaha RK, Aggarwal R et al. High prevalence of polycystic ovary syndrome characteristics in girls with euthyroid chronic lymphocytic thyroiditis: a case-control study. Eur J Endocrinol 2010; 162: 1117-1122
  • 9 Hak AE, Pols HA, Visser TJ et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132: 270-278
  • 10 Hahn S, Tan S, Sack S et al. Prevalence of the metabolic syndrome in German women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2007; 115: 130-135
  • 11 Hashimoto H. Zur Kenntnis der lymphomatösen Veränderung der Schilddrüse (struma lymphomatosa). Archiv für klinische Chirurgie 1912; 97: 219-248
  • 12 Imaizumi M, Akahoshi M, Ichimaru S et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004; 89: 3365-3370
  • 13 Janssen OE, Benker G. Schilddrüse: Reproduktionsmedizinische Aspekte – Update 2011. J Reproduktionsmed Endokrinol 2011; 8: 22-31
  • 14 Janssen OE, Mehlmauer N, Hahn S et al. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol 2004; 150: 363-369
  • 15 Kachuei M, Jafari F, Kachuei A et al Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet 2012; 285: 853-856
  • 16 Shaw LJ, Bairey Merz CN, Azziz R et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health – National Heart, Lung, and Blood Institute sponsored Women’s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008; 93: 1276-1284
  • 17 Solomon CG, Hu FB, Dunaif A et al. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 2002; 87: 2013-2017
  • 18 Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; DOI: 10,1136/bmj.d2616.:d2616.
  • 19 Stein IF, Leventhal ML. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181-191
  • 20 Tan S, Hahn S, Janssen OE. The polycystic ovary syndrome – metabolic consequences. Gynakol Geburtshilfliche Rundsch 2008; 48: 16-23
  • 21 The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25
  • 22 Thangaratinam S, Tan A, Knox E et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011; 342: d2616
  • 23 Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP. et al. (ed. Polycystic Ovary Syndrome. Boston: Blackwell Scientific Publications; 1992: 377-384