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.