Raised Thyroid Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions.

Introduction Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in non-obese adolescents with PCOS, including the effects of randomized interventions. Methods Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) in non-obese adolescents with PCOS. A post-hoc analysis compared: TSH levels in PCOS (N= 62) vs controls; TSH changes on treatment (for 1 year); TSH levels post treatment (for 1 year). Results Mean TSH levels were higher in PCOS patients than in control girls (P<0.01). On-treatment TSH levels diverged (P<0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Post-treatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R= 0.307, P= 0.017). Conclusion The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in non-obese adolescents with PCOS are herewith extended to include on- and post-treatment TSH.