Clinical Implications
Metabolic comorbidities are also note-worthy in interpreting the risk of Graves’ diseases in PCOS. In our study, patients with DM and CAD have more risk to develop Graves’ diseases. Adverse metabolic outcomes in PCOS have been widely discussed in previous studies, such as impaired glucose tolerance, insulin resistance, DM, cardiovascular disease, and metabolic syndrome.(20) Obesity exacerbates many of these subsequent outcomes such as DM.(21) Higher metabolic inflexibility was observed to be associated with hyperandrogenemia and insulin resistance in PCOS patients,(22) as a result of an inflammation status triggered by saturated fat ingestion, may be a separate and distinct contributor independent from obesity.(23) Obesity increases leptin and TRH level, which further raise TSH and induce proliferation of adipocytes again via TSH receptors. Leptin also lead to autoimmunity by up‑regulating effector T‑cells and down‑regulating regulator T‑cells.(24)
Additionally, in our study, patients with depression were prone to develop Graves’ diseases with a subtle but insignificant aHR of 1.57 (95%C.I. 0.92-2.67). Little but consistent evidence for psychological issues in PCOS patients was presented in previous studies.(25-28) Objective measurements such as obesity, insulin resistance, and elevated serum androgens might partly contribute to the association of depression and PCOS, but the conclusion remains controversial.(27, 28) Since comorbidities sustained in our study were proven to reduce the quality of life for patients with PCOS, physicians are suggested to closely monitor the progression of high-risk comorbidities in PCOS patients.