Association Between Polycystic Ovary Syndrome And Thyroid Autoimmune Damage:a Meta-analysis

Objective Polycystic ovary syndrome(PCOS)and autoimmune thyroid disease(AITD)are common diseases in women of childbearing age,and they are also important factors affecting conception and pregnancy outcomes.Correlative components of PCOS have been reported to be related to the occurrence of thyroid autoimmune damage in previous studies,but there have been also inconsistent or uncertain reports.The purpose of the present study was to further evaluate the correlation between PCOS and thyroid autoimmune damage through meta-analysis,so as to provide a theoretical basis for the screening,diagnosis and treatment of thyroid disease in patients with PCOS.Methods Related research literatures were searched in PubMed(MEDLINE),EMBASE,China Knowledge Network(CNKI),Wanfang Database,Web of Science and other databases from January 1,2000 to December 31,2019.And the one-off primary studies about the relationship between PCOS and AITD were collected.Meta-analysis was performed using Review Manager 5.3 software.The combined odds ratio(OR),mean difference(MD),and 95%confidence interval(95%CI)were used to evaluate the correlation between PCOS and thyroid autoimmune injury.Meanwhile,the heterogeneity of the studies were determined by the I2 test,and the sensitivity analysis of related results was conducted as well.In addition,the publication bias was evaluated by Egger’s funnel plots and Begg’s test using STATA 12.0 software.Results Seven studies from the 653 documents initially selected were included in the meta analysis,including six papers written in English and one paper written in Chinese,involving 709 cases of patients with PCOS and 747 cases with no PCOS patients as the control group.There was no significant heterogeneity between PCOS and thyroid specific antibodies,prevalence of AITD(both P>0.1),so fixed-effect model was used for meta-analysis.The results showed thatthe positive rate of thyroid peroxidase antibody(TPOAb)(OR=2.94,95%CI:2.17-3.98,P<0.01),the positive rate of thyroglobulin antibody(TgAb)(OR=2.48,95%CI:1.67-3.67,P<0.01)and the prevalence of AITD(OR=3.70,95%CI:2.61-5.27,P<0.01)were significantly increased in patients with PCOS compared with the control group.However,there was no significant differences in serum thyroid stimulating hormone(TSH)levels between the two groups(overall effect result Z=0.40,P=0.69).Although,in the analysis of serum testosterone levels,MD was 0.42,95%CI:0.09-0.76,P=0.01,the heterogeneity was high,the results were unstable,and the reliability was poor.In addition,the results of Egger’s and Begg’s tests suggested that the outcomes were reliable and stable,which indicating there is no publication bias(P>0.05).Conclusion There is a obvious correlation between PCOS and thyroid organ-specific autoimmune damage,therefore PCOS patients have a higher risk of AITD.With the development of autoimmune damage,the thyroid function may be affected,which in turn affects the adverse perinatal outcome in women of childbearing age.Therefore,even if there is no obvious clinical manifestation related to thyroid disease in patients with PCOS,thyroid function and thyroid-specific autoimmune antibodies screening should be considered to guide the diagnosis and treatment of AITD,so as to improve the prognosis of patients.