PCOS Thyroid Connection

Thyroid disorders are also pervasive endocrine disorders in women, particularly Hashimoto’s thyroiditis, which is autoimmune hypothyroidism (low thyroid function). Hashimoto’s thyroiditis is the most common autoimmune disorder in women and the most common thyroid disorder. Most hypothyroid cases are Hashimoto’s thyroiditis. This article will primarily focus on Hashimoto’s and hypothyroidism as it relates to PCOS.

Thyroid hormones, produced by the thyroid gland, regulate metabolism and reproduction and affect all cells in the body. Because of this influence, thyroid disorders affect the menstrual cycle, fertility, and metabolic health, which can look like PCOS.  

The Connection Between PCOS and Thyroid Hormones

First, both PCOS and hypothyroidism can have similar or overlapping symptoms, including:

• Weight gain, increased BMI
• Insulin resistance
• Fertility challenges, miscarriage
• Increased cardiometabolic risk
• Imbalanced lipids (including high cholesterol)
• Fatigue
• Digestive symptoms
• Changes in hair and skin
• Poor circulation
• Brain fog
• Increased inflammation
• Anxiety and Depression

A PCOS diagnosis requires ruling out thyroid dysfunction, but it’s not always that simple; two conditions can occur together.

There is a bidirectional relationship between PCOS and thyroid dysfunction, primarily hypothyroidism. They have common aspects, such as insulin resistance, autoimmunity, and inflammation. Both increase the risk of diabetes, obesity, cardiovascular disease, fertility problems, and pregnancy complications. Having both conditions makes these risks even greater.

The prevalence of thyroid disorders is higher in women with PCOS than women without. One study showed Hashimoto’s thyroiditis occurring in 22.8% of women with PCOS compared to 5.7% in the non-PCOS group of healthy controls. Another study suggested that women with PCOS had more than twice the chance of developing thyroid disorders over time.

Women with PCOS and hypothyroidism (as defined by elevated TSH) can have worse health outcomes over time. Thyroid abnormalities have an even more significant impact on the reproductive system.

On the other hand, hypothyroidism affects the ovaries and can promote polycystic changes. Hypothyroidism alone doesn’t cause PCOS, but it can exacerbate endocrine dysfunction. One study concludes: “Thyroid plays a crucial role in the pathogenesis, development, and progression of PCOS. Therefore, patients with PCOS require rigorous thyroid function detection, monitoring, and correction over time, which will mitigate or perhaps fully prevent the further deterioration of PCOS symptoms.”

The Complexity

Hashimoto’s thyroiditis and PCOS share some common mechanisms, yet we are still trying to understand the connections and complexity.

The HPO axis (hypothalamic pituitary ovarian axis) and HPT axis (hypothalamic pituitary thyroid axis) share the brain initiation of the hormonal cascades. Dysfunction in hypothalamic-pituitary signaling can affect both pathways.

It’s well-established that Hashimoto’s is an autoimmune condition. The immune system creates autoantibodies to the thyroid gland, leading to inflammation, tissue destruction, and a decline in thyroid hormone production. Some argue that PCOS has an autoimmune nature as well, as PCOS patients may be more prone to autoantibodies and inflammation.

There may also be a connection with estrogen. Thyroid hormones influence estrogen production (in the ovaries), and estrogen dominance is common in PCOS. Further, estrogen plays a crucial role in immune function and autoimmunity.

Additionally, we must consider environmental factors. Endocrine-disrupting chemicals can affect the thyroid and ovaries and disrupt hormonal signaling at receptor sites throughout the body.

We still don’t fully understand all the connections, but it’s clear that there are many factors to consider concerning PCOS-thyroid health.

PCOS Thyroid Action Steps

Conventional medicine will offer medications for PCOS, including metformin for metabolic support and birth control pills to suppress the menstrual cycle (and symptoms). For hypothyroidism, doctors can help you replace thyroid hormones. While these interventions are helpful and often necessary, they don’t get to the root cause or consider the interconnectedness of hormonal systems.

An integrative approach offers the same allopathic options, along with many other tools to not only manage symptoms, but to reverse disease to the extent it is possible. We also have an eye on prevention and can help catch imbalances earlier.

It’s common for women to see provider after provider for years before getting an accurate diagnosis. At TārāMD, we spend time with you to understand your history, do comprehensive lab work to assess the imbalances and root causes, and work with you to implement a personalized strategy to include lifestyle changes, nutrition, supplements, and medications as indicated. It’s a different model than you are used to in conventional care, with better outcomes.

Here are some strategies to consider for PCOS, thyroid concerns, or both:

• Test Your Thyroid – If you have PCOS, check thyroid hormones regularly. If you have any symptoms of PCOS or thyroid dysfunction, have your thyroid hormones tested along with a complete hormone workup. Thyroid disorders tend to present during times of hormonal transition, including pregnancy, postpartum, and perimenopause; these are also good time to get tested.

• Ask for a Full Thyroid Panel – All too often, providers test TSH (thyroid-stimulating hormone) or TSH and T4 (thyroxine) only. This does not give a complete thyroid picture or tell us anything about your active thyroid hormone T3 (triiodothyronine) levels. Further, the lab range for TSH is much wider than the optimal, functional range. You could still have “normal” labs and be experiencing thyroid dysfunction.

At a minimum, a full panel should include TSH, free T4, free T3, and thyroid antibodies. Your TārāMD may want to look at additional thyroid labs, nutrient levels, and other hormones as well.

• Focus on the root causes. The hormone imbalance itself, whether low thyroid hormone or high androgens in PCOS, isn’t the root cause. You must dig down another layer to uncover what is driving the imbalances. It’s likely not just one thing but a combination of lifestyle factors, nutrient deficiencies, gut imbalances, infections, toxin exposures, stress, etc. Genetics can also play a role, but our focus will be on what we can control. (Luckily, all the lifestyle factors influence genetic expression). This is truly the art of the integrative approach, and a skilled practitioner can help you home in on your root causes.

• Take the pressure off weight. So many times, we get pressure from ourselves or society to solely focus on weight. Since both PCOS and hypothyroidism can result in weight gain or weight loss resistance, it’s easy to solely focus on weight loss, thinking that losing weight will improve health. In fact, the opposite is true. Focus on creating more health and balance in the body by addressing the root causes will often allow weight to naturally release without having to manipulate it. Read more about PCOS weight loss here.

• Utilize personalized nutrition care – You don’t need to follow one restrictive diet for PCOS and another to support thyroid health. A personalized nutrition plan will address all concerns comprehensively. The focus will be on nourishing the body with nutrient-dense whole foods targeted at supporting gut health, balancing blood sugar, and repleting nutrient stores. Work with your TārāMD integrative nutritionist for guidance and support at each step.

Save yourself time, money, and agony by working with an integrative physician and team to address your PCOS, thyroid, and other women’s health concerns. We can help you understand the patterns that may be out of balance and help you course correct. While we can prescribe needed medications like your PCP, we also do the additional work to identify and treat your root causes. Your treatment plan will be as unique as you, and healing is just around the corner!

References

1. Wrońska, K., Hałasa, M., & Szczuko, M. (2024). The Role of the Immune System in the Course of Hashimoto's Thyroiditis: The Current State of Knowledge.International journal of molecular sciences, 25(13), 6883.
2. Palomba, S., Colombo, C., Busnelli, A., Caserta, D., & Vitale, G. (2023). Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature.Frontiers in endocrinology, 14, 1251866.
3. Singla, R., Gupta, Y., Khemani, M., & Aggarwal, S. (2015). Thyroid disorders and polycystic ovary syndrome: An emerging relationship.Indian journal of endocrinology and metabolism, 19(1), 25–29.
4. Fan, H., Ren, Q., Sheng, Z., Deng, G., & Li, L. (2023). The role of the thyroid in polycystic ovary syndrome.Frontiers in endocrinology, 14, 1242050.