Overt hypothyroidism is associated with the presence of uterine leiomyoma: a retrospective analysis

Navigating the thyroid-gynecologic interplay: a systematic review and meta-analysis

Thyroid disorders are considered to be linked to various health issues, including gynecologic cancers. Studying this association is crucial in clinical practice. This approach was applied through searches in Scopus, WOS, PubMed, and Google Scholar. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. The quality assessment was checked. The meta-analyses were performed using R-4.3.2 (R Core Team, Vienna, Austria) and SPSS version 28 (SPSS Inc., Armonk, NY, USA). The results demonstrated that 19 studies investigated the association between thyroid disorders and gynecologic cancers in adult females. The studies were categorized into two groups: group 1 examined thyroid status in various gynecologic cancers, while group 2 comprised casecontrol studies examining gynecologic cancer incidence in females with thyroid disorders compared to control. Among females with gynecologic cancers, 13% (95% confidence interval [CI], 10-17%) had hypothyroidism. When comparing hypothyroidism and hyperthyroidism across studies, the overall percentage for hypothyroidism was 14% (95% CI, 9-22%), while for hyperthyroidism, it was 3% (95% CI, 2-5%). The odds ratio for hypothyroidism in females with uterine cancer was 2.65 (P<0.05). Additionally, hypothyroidism showed a significant risk ratio of 1.3 (P<0.05) for different gynecologic cancers. However, hyperthyroidism was significantly associated with increased ovarian cancer mortality (risk ratio [RR], 2.14; P=0.03); conversely, hypothyroidism showed no significant relationship (RR, 1.35; P=0.26). The findings concluded that hypothyroidism is significantly associated with various gynecologic cancers, suggesting a potential role in its pathogenesis. Conversely, hyperthyroidism is linked to an increased risk of ovarian cancer mortality. Further research is needed to clarify whether hyperthyroidism predisposes females to ovarian cancer.

Cardiometabolic profile of women with uterine leiomyoma: a cross-sectional study

BACKGROUND

Emerging evidence suggests that cardiometabolic risk factors contribute to uterine leiomyoma development, but cardiometabolic profiles of women with the tumor remain poorly defined. This study aimed to determine the association of cardiometabolic comorbidities and cardiometabolic medication use with a leiomyoma diagnosis.

METHODS

In this cross-sectional study, aggregate-level data from 2013-2020 were collected using the SlicerDicer feature of Epic (Epic, Verona, WI, USA) electronic medical record system. Women ≥18 years with at least one visit or hospital encounter at the Johns Hopkins Health System (N.=679,981) were assigned as cases or controls according to leiomyoma status. Individual prevalence of each prespecified cardiometabolic comorbidity and relevant prescription medications was obtained. Prevalence Odds Ratios were used to assess the association of cardiometabolic comorbidities and medication use with uterine leiomyoma.

RESULTS

Women with uterine leiomyoma (N.=27,703) were more likely to be obese (2.56; 95% CI: 2.49-2.63), have metabolic syndrome (1.82; 95% CI: 1.51-2.19), essential hypertension (1.45; 95% CI: 1.42-1.49), diabetes mellitus (1.29; 95% CI: 1.24-1.33) and hyperlipidemia (1.23; 95% CI: 1.19-1.26). These associations were stronger among younger women and persisted after excluding those with a hysterectomy. Notably, statins were the only medications associated with a lower leiomyoma risk (0.81; 95% CI: 0.79-0.84).

CONCLUSIONS

Uterine leiomyoma is associated with a spectrum of cardiometabolic comorbidities and use of associated medications, constituting an unfavorable cardiometabolic profile in women with the tumor. If definitively correlated, prevention and early management of cardiometabolic risk factors may decrease uterine leiomyoma incidence, and screening women with uterine leiomyoma for cardiometabolic comorbidities may aid in cardiovascular disease prevention.

Intravascular leiomyomatosis: a continuing diagnostic challenge

We report the case of a woman in her 60s with intravascular leiomyomatosis. She suffered from numerous non-specific symptoms including weight loss, anaemia and sudden swelling of the left lower extremity. CT imaging showed the presence of an enlarged left ovary and a thrombus extending from the left ovarian venous plexus intruding into the right atrium of the heart. Cancer antigen 125 was 20 U/mL. Pelvic transvaginal ultrasound examination identified two normal ovaries and a mass adjacent to the left ovary. A second opinion on the CT scan was requested at a oncogynaecological multidisciplinary team meeting, where the radiologist of the team identified an intervascular leiomyomatosis. After further investigation, surgical treatment was planned and completed in collaboration with the departments of cardiothoracic and vascular surgery. The patient recovered fully.

Uterine fibroids increase the risk of thyroid goiter and thyroid nodules

Uterine fibroid and benign thyroid disease are both common diseases in women. This study aimed to evaluate whether these diseases are related. We established the uterine fibroid group according to diagnosis and surgery codes using the Korea National Health Insurance data from 2009 to 2020. All women from 20 to 50 years old who underwent uterine myomectomy from 2009 to 2020 were identified. We selected the control group by performing a 1:1 propensity score matching on age at 5-year intervals, socioeconomic status (SES), region, Charlson comorbidity index (CCI), menopause, and year among women who visited a medical institution for a health check-up. Thyroid disease cases were selected using the thyroid disease diagnosis code and thyroid-associated laboratory tests. A total of 181,419 patients were included in the uterine fibroid and control groups. The median age of each group was 40 (range, 35 ~ 44) and 40 (range, 35 ~ 45) years old, respectively. Benign thyroid disease affected 1162 (0.6%) in the uterine fibroid group and 1137 (0.6%) in the control group. Among the benign thyroid diseases, hypothyroidism was the most common in both groups, followed by a nontoxic single thyroid nodule. The uterine fibroid group had a higher risk of thyroid goiter (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022-1.338), nontoxic single thyroid nodule (HR 1.268, 95% CI 1.182-1.361), and total thyroid disease (HR 1.078, 95% CI 1.036-1.121) in stratified Cox regression analysis adjusted for age, SES, region, CCI, parity, menopause, hypertension, diabetes, dyslipidemia, systemic lupus erythematosus, irritable bowel syndrome, Crohn's disease, and endometriosis than the control group. The results suggest that women with uterine fibroids have an increased risk of thyroid goiters and thyroid nodules. Although the mechanism is not well known, estrogen and iodide might be a link between uterine fibroids and thyroid goiters and nodules. Future studies that prospectively follow women with uterine fibroids across a lifetime are needed.

Postmenopausal Uterine Leiomyomas and Chronic Lymphadenopathy: Exploring Epigenetic Changes and Pathophysiology

Uterine leiomyomas (LM) are tumors arising from the non-neoplastic proliferation of smooth muscle cells within the myometrium. Like benign tumors, LM are not generally spread through the lymphatic system, and therefore should not be associated with lymphadenopathy. Herein, we present a case of a 60-year-old female who presented to the clinic with postmenopausal bleeding in the setting of sonographically evident uterine LM and abdominal lymphadenopathy. A lymph node biopsy revealed plasma cells and an eosinophilic material presumptively diagnosed as amyloid. She then underwent an abdominal hysterectomy for definitive treatment of LM. Surgical pathology confirmed the clinical diagnosis of uterine and cervical leiomyoma. Current literature suggests that genetic and epigenetic abnormalities contribute to the pathogenesis of LM in addition to hormonal signals such as estrogen and progesterone. It is unusual for LM to occur in post-menopausal women due to reduced hormonal influence. Therefore, this case explored an alternative mechanism of tumor proliferation. This case hypothesizes that genetic mutations and epigenetic changes resulting from chronic inflammatory offenses contributed to LM growth and lymphadenopathy.

Relationship between thyroid disorders and uterine fibroids among reproductive-age women

Uterine fibroids and thyroid nodules, both of which are crucially affected by estrogen, are common diseases among reproductive-age women. However, little attention has been paid to the association between the two diseases. This retrospective case-control study aimed to assess the relationships among thyroid nodules, thyroid function and uterine fibroids in China. We reviewed the electronic records of 853 reproductive-age women who attended health check-ups at the Second Affiliated Hospital of Wenzhou Medical University from July 1st, 2017, to June 30th, 2018. All subjects received transvaginal pelvic ultrasound, thyroid ultrasound, thyroid function, and other laboratory tests. We found that the prevalence of thyroid nodules in subjects with uterine fibroids was remarkably higher than that in subjects without fibroids. The proportion of thyroid nodules ≥1 cm in subjects with uterine fibroids was significantly higher than that in subjects without fibroids. Women with thyroid nodules had a higher proportion of multiple uterine fibroids than women without thyroid nodules. Among the parameters of thyroid function, the only statistically significant parameter was total triiodothyronine, i.e., women with uterine fibroids had lower total triiodothyronine levels than unaffected controls; however, the total triiodothyronine levels were within the normal ranges. Moreover, no significant difference was noted in thyroid hormone status between subjects with and without uterine fibroids. Our findings suggest that thyroid nodules are positively correlated with uterine fibroids among reproductive-age women in China. Further studies are needed to confirm this association and fully understand the common pathogenetic mechanism underlying the association between uterine fibroids and thyroid nodules.

Hypothyroidism induces uterine hyperplasia and inflammation related to sex hormone receptors expression in virgin rabbits

AIMS

In women, uterine alterations have been associated with sex steroid hormones. Sex hormones regulate the expression of thyroid hormone receptors (TRs) in the uterus, but an inverse link is unknown. We analyzed the impact of hypothyroidism on histological characteristics, vascular endothelial growth factor (VEGF-A), progesterone receptors (PR), estrogen receptors (ER), thyroid hormone receptors (TRs), perilipin (PLIN-A), and lipid content in the uterus of virgin rabbits.

MAIN METHODS

Twelve Chinchilla-breed adult female rabbits were grouped into control (n = 6) and hypothyroid (n = 6; 0.02% of methimazole for 30 days). The thickness of endometrium and myometrium, number of uterine glands, and infiltration of immune cells were analyzed. The expression of VEGF-A, PR, ERα, and PLIN-A was determined by RT-PCR and western blot. The uterine content of triglycerides (TAG), total cholesterol (TC), and malondialdehyde (MDA) was quantified.

KEY FINDINGS

Hypothyroidism promoted uterine hyperplasia and a high infiltration of immune cells into the endometrium, including macrophages CD163+. It also increased the expression of VEGF-A, TRA, and ERα-66 but reduced that of PR and ERα-46. The uterine content of PLIN-A, TAG, and TC was reduced, but that of MDA was augmented in hypothyroid rabbits.

SIGNIFICANCE

Our results suggest that uterine hyperplasia and inflammation promoted by hypothyroidism should be related to changes in the VEGF-A, PR, ER, and TRs expression, as well as to modifications in the PLIN-A expression, lipid content, and oxidative status. These results suggest that hypothyroidism should affect the fertility of females.

Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort

BACKGROUND

Thyroid cancers are threefold more frequent in women than in men. A role of reproductive or hormonal factors has been suggested but with contradictory results. We investigated potential associations between history of hysterectomy, with or without oophorectomy, and history of benign gynaecological disease (uterine fibroids, endometriosis) and the incidence of differentiated thyroid cancer, in a large French prospective cohort.

METHODS

A total of 89 340 women from the E3N cohort were followed up between 1990 and 2012. Gynaecological diseases treated by surgery were self-reported. Thyroid cancers were validated by histological reports. Time-dependent covariates included smoking status, BMI and history of benign thyroid disease. Cox proportional hazard models with age as timescale were used to estimate Hazard Ratios (HR) and 95% confidence intervals (CI).

RESULTS

A total of 412 cases of thyroid cancer were diagnosed during follow-up. A history of hysterectomy was associated with an increased risk of differentiated thyroid cancer (adjusted HR=2.05; 95%CI: 1.65-2.55). The association was not altered after further adjustment for reproductive factors. Endometriosis, uterine polyps, ovarian cysts and oophorectomy without hysterectomy were not associated with the risk of thyroid cancer. A history of fibroids was also significantly related to the risk of thyroid cancer over the follow-up period (adjusted HR=1.91; 95%CI: 1.50-2.44) and the increased risk persisted after adjustment for history of hysterectomy.

CONCLUSIONS

Women who had either a history of fibroids or hysterectomy had an increased risk of differentiated thyroid cancer. These findings suggest shared biological mechanisms between fibroids and thyroid cancer, which deserve to be further dissected.

Maternal and Paternal Infertility Disorders and Treatments and Autism Spectrum Disorder: Findings from the Study to Explore Early Development

Previous studies of associations between ASD and conception using assisted reproductive technology (ART) are inconsistent and few studies have examined associations with other infertility treatments or infertility disorders. We examined associations between ASD and maternal/paternal infertility disorders and numerous maternal treatments among 1538 mother-child pairs in the Study to Explore Early Development, a population-based case-control study. ASD was associated with any female infertility diagnosis and several specific diagnoses: blocked tubes, endometriosis, uterine-factor infertility, and polycystic ovarian syndrome. Stratified analyses suggested associations were limited to/much stronger among second or later births. The findings were not explained by sociodemographic factors such as maternal age or education or multiple or preterm birth. ASD was not associated with ART or non-ART infertility treatments.

A multi-stage genome-wide association study of uterine fibroids in African Americans

Uterine fibroids are benign tumors of the uterus affecting up to 77% of women by menopause. They are the leading indication for hysterectomy, and account for $34 billion annually in the United States. Race/ethnicity and age are the strongest known risk factors. African American (AA) women have higher prevalence, earlier onset, and larger and more numerous fibroids than European American women. We conducted a multi-stage genome-wide association study (GWAS) of fibroid risk among AA women followed by in silico genetically predicted gene expression profiling of top hits. In Stage 1, cases and controls were confirmed by pelvic imaging, genotyped and imputed to 1000 Genomes. Stage 2 used self-reported fibroid and GWAS data from 23andMe, Inc. and the Black Women's Health Study. Associations with fibroid risk were modeled using logistic regression adjusted for principal components, followed by meta-analysis of results. We observed a significant association among 3399 AA cases and 4764 AA controls at rs739187 (risk-allele frequency = 0.27) in CYTH4 (OR (95% confidence interval) = 1.23 (1.16-1.30), p value = 7.82 × 10-9). Evaluation of the genetic association results with MetaXcan identified lower predicted gene expression of CYTH4 in thyroid tissue as significantly associated with fibroid risk (p value = 5.86 × 10-8). In this first multi-stage GWAS for fibroids among AA women, we identified a novel risk locus for fibroids within CYTH4 that impacts gene expression in thyroid and has potential biological relevance for fibroids.

Multiple clinical characteristics separate MED12-mutation-positive and -negative uterine leiomyomas

Up to 86% of uterine leiomyomas harbour somatic mutations in mediator complex subunit 12 (MED12). These mutations have been associated with conventional histology, smaller tumour size, and larger number of tumours within the uterus. Prior studies, with limited sample sizes, have failed to detect associations between other clinical features and MED12 mutations. Here, we prospectively collected 763 uterine leiomyomas and the corresponding normal myometrial tissue from 244 hysterectomy patients, recorded tumour characteristics, collected clinical data from medical records, and screened the tissue samples for MED12 mutations to assess potential associations between clinical variables and mutation status. Out of 763 leiomyomas, 599 (79%) harboured a MED12 mutation. In the analysis of tumour characteristics, positive MED12-mutation status was significantly associated with smaller tumour size, conventional histology, and subserous location, relative to intramural. In the analysis of clinical variables, the number of MED12-mutation-positive tumours showed an inverse association with parity, and the number of mutation-negative tumours showed a positive association with a history of pelvic inflammatory disease. This study confirmed the previously reported differences and discovered novel differentiating features for MED12-mutation-positive and -negative leiomyomas. These findings emphasise the relevance of specific driver mutations in genesis and presentation of uterine leiomyomas.

Endometriosis: a high-risk population for major chronic diseases?

BACKGROUND

Despite an estimated prevalence of 10% in women, the etiology of endometriosis remains poorly understood. Over recent decades, endometriosis has been associated with risk of several chronic diseases, such as cancer, autoimmune diseases, asthma/atopic diseases and cardiovascular diseases. A deeper understanding of these associations is needed as they may provide new leads into the causes or consequences of endometriosis. This review summarizes the available epidemiological findings on the associations between endometriosis and other chronic diseases and discusses hypotheses for underlying mechanisms, potential sources of bias and methodological complexities.

METHODS

We performed a comprehensive search of the PubMed/Medline and ISI Web of Knowledge databases for all studies reporting on the associations between endometriosis and other diseases published in English through to May 2014, using numerous search terms. We additionally examined the reference lists of all identified papers to capture any additional articles that were not identified through computer searches.

RESULTS

We identified 21 studies on the associations between endometriosis and ovarian cancer, 14 for breast cancer, 8 for endometrial cancer, 4 for cervical cancer, 12 for cutaneous melanoma and 3 for non-Hodgkin's lymphoma, as well as 9 on the links between endometriosis and autoimmune diseases, 6 on the links with asthma and atopic diseases, and 4 on the links with cardiovascular diseases. Endometriosis patients were reported to be at higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer.

CONCLUSIONS

Increasing evidence suggests that endometriosis patients are at higher risk of several chronic diseases. Although the underlying mechanisms are not yet understood, the available data to date suggest that endometriosis is not harmless with respects to women's long-term health. If these relationships are confirmed, these findings may have important implications in screening practices and in the management and care of endometriosis patients.