Erman ÇAKAL, Muhammed Erkam SENCAR, Murat ÇALAPKULU, İlknur ÖZTÜRK ÜNSAL, Sema HEPŞEN, Ali YALÇINDAĞ

Evaluation of serum anti-Müllerian hormone levels in women with Hashimoto thyroiditis in the reproductive age

Background/aim: Autoimmune thyroid disease in women is associated with subfertility and early pregnancy loss, and patients with primary ovarian insufficiency have a high prevalence of thyroid autoimmune disorders. The aim of this study was to investigate the association between Hashimoto thyroiditis (HT) and ovarian reserve. Materials and methods: Levels of serum thyroid stimulating hormones, thyroid autoantibodies, and anti-Müllerian hormone (AMH) were measured in women with HT and a healthy control group between 2018 and 2019. Results: Evaluation was made of 108 premenopausal women with HT, and a control group of 172 healthy females with normal antithyroid antibody levels and thyroid function. Serum AMH levels were determined to be significantly lower in the HT group compared to the control group. Conclusion: Ovarian reserve evaluated by serum AMH concentration is affected by thyroid autoimmunity independently of antithyroid antibodies type or titers.Key words: Hashimoto thyroiditis, anti-Müllerian hormone, ovarian reserve, miscarriage

PDF

___

1. Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reproductive Biology and Endocrinology 2016; 14 (1): 26. doi: 10.1186/s12958-016-0162-0
2. Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB et al. Pathophysiological aspects of thyroid hormone disorders/ thyroid peroxidase autoantibodies and reproduction. Human Reproduction Update 2015; 21 (3): 378-387. doi: 10.1093/ humupd/dmv004
3. Aljarad M, Alhalabi N, Hamad A, Nmr N, Abbas F et al. Prevalence of thyroid autoimmune antibodies in women seeking fertility care in Damascus, Syria. Cureus 2019; 11 (8): e5315. doi: 10.7759/cureus.5315
4. Kuroda K, Uchida T, Nagai S, Ozaki R, Yamaguchi T et al. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Mullerian hormone in infertile women of reproductive age. Journal of Assisted Reproduction and Genetics 2015; 32 (2): 243-247. doi: 10.1007/s10815-014-0397-7
5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocrine Reviews 2010; 31 (5): 702-755. doi: 10.1210/er.2009-0041
6. Bahri S, Tehrani FR, Amouzgar A, Rahmati M, Tohidi M et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12- year follow up. BMC Endocrine Disorders 2019; 19 (1): 47. doi: 10.1186/s12902-019-0370-7
7. Vadasz Z, Haj T, Kessel A, Toubi E. Age-related autoimmunity. BMC Medicine 2013; 11: 94. doi: 10.1186/1741-7015-11-94
8. Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. American Journal of Obstetrics and Gynecology 2017; 217 (2): 129-140. doi: 10.1016/j.ajog.2017.02.027
9. Broer SL, Broekmans FJM, Laven JSE, Fauser BCJM. AntiMullerian hormone: ovarian reserve testing and its potential clinical implications. Human Reproduction Update 2014; 20 (5): 688-701. doi: 10.1093/humupd/dmu020
10. Erol O, Parlak M, Ellidağ HY, Parlak AE, Derbent AU et al. Serum anti-Mullerian hormone levels in euthyroid adolescent girls with Hashimoto’s thyroiditis: relationship to antioxidant status. Europen Journal of Obstetrics and Gynecology and Reproductive Biology 2016; 203: 204-209. doi: 10.1016/j.ejogrb.2016.06.002
11. Osuka S, Iwase A, Goto M, Takikawa S, Nakamura T et al. Thyroid autoantibodies do not impair the ovarian reserve in euthyroid infertile women: a cross-sectional study. Hormone and Metabolic Research 2018; 50 (7): 537-542. doi: 10.1055/a-0637- 9430
12. Tüten A, Hatipoğlu E, Öncül M, İmamoğlu M, Acikgöz AS et al. Evaluation of ovarian reserve in Hashimoto’s thyroiditis. Gynecological Endocrinology 2014; 30 (10): 708-711. doi: 10.3109/09513590.2014.926324
13. Özalp AE, Aycan Z. Evaluation of the ovarian reserve in adolescents with Hashimoto’s thyroiditis using serum antiMullerian hormone levels. Journal of Clinical Research in Pediatric Endocrinology 2018; 10 (4): 331-335. doi: 10.4274/ jcrpe.0047
14. Košir PR, Meden VH, Vizjak A, Uršula LA, Slabe N. Possible role of autoimmunity in patients with premature ovarian insufficiency. Internation Journal of Fertility and Sterilitiy 2014; 7 (4): 281-290.
15. Dragojević-Dikić S, Marisavljević D, Mitrović A, Dikić S, Jovanović T. An immunological insight into premature ovarian failure (POF). Autoimmunity Reviews 2010; 9 (11): 771-774. doi: 10.1016/j.autrev.2010.06.008
16. Ayesha VJ, Goswami D. Premature ovarian failure: an association with autoimmune diseases. Journal of Clinical Diagnostic Research 2016; 10 (10): 10-12. doi: 10.7860/ JCDR/2016/22027.8671
17. Pirgon O, Sivrice C, Demirtaş H, Dündar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecological Endocrinology 2016; 32 (4): 306- 310. doi: 10.3109/09513590.2015.1116510
18. Biondi B. The normal TSH reference range: what has changed in the last decade? The Journal of Clinical Endocrinology and Metabolism 2013; 98 (9): 3584-3587. doi: 10.1210/jc.2013- 2760
19. Kuroda M, Kuroda K, Segawa T, Noh JY, Yoshihara A et al. Levothyroxine supplementation improves serum antiMullerian hormone levels in infertile patients with Hashimoto’s thyroiditis. The Journal of Obstetrics and Gynaecolgy Research 2018; 44 (4): 739-746. doi: 10.1111/jog.13554
20. Chen CW, Huang YL, Tzeng CR, Huang RL, Chen CH. Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid 2017; 27 (9): 1194-1200. doi: 10.1089/thy.2017.0139
21. Sağlam F, Önal ED, Ersoy R, Koca C, Ergin M et al AntiMullerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease. Gynecological Endocrinology 2015; 31 (2): 165-168. doi: 10.3109/09513590.2014.973391
22. Glinoer D. Miscarriage in women with positive anti-TPO antibodies: is thyroxine the answer? The Journal of Clinical Endocrinology and Metabolism 2006; 91 (7): 2500-2502. doi: 10.1210/jc.2006-0834
23. Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic reviewand metaanalysis. PLoS ONE 2017; 12 (4): e0175708. doi: 10.1371/ journal.pone.0175708