Premature ovarian insufficiency in patients with thyroid-related poly-autoimmunity

An anticipated menopause is a disquieting health problem; its association with autoimmune disorders has been reported. However, data about the presence of premature ovarian insufficiency (POI) and early menopause (EM) framed in thyroid-related poly-autoimmunity are rather scanty. In this view, we described the presence of a precocious menopause in a large cohort of women with autoimmune thyroid disease (ATD) isolated or framed in poly-autoimmune syndromes.

The characteristics of 7,690 postmenopausal women has been evaluated in a tertiary center for thyroid diseases. To be included, women must have been menopausal for at least 3 years without any menstrual bleeding. Three subgroups were examined and compared: women with nonautoimmune endocrinopathies (n = 5,697; group A), representing an internal control, or with isolated ATD (n = 1,689; group B) or with thyroid-related poly-autoimmunity (n = 304; group C).

In the whole sample, 213 (2.77%) women experienced unexplained precocious menopause, 115 (1.50%) showed spontaneous premature ovarian insufficiency (POI), and 98 (1.27%) experienced early menopause (EM). The prevalence of POI was higher in women with thyroid-related poly-autoimmunity (group C) than in group B and A (5.92 vs. 1.84 vs. 1.16%; p < 0.0001). A spontaneous miscarriage was observed in 52/213 women (24.4%) with precocious menopause (EM + POI), being significantly higher in women with poly-autoimmunity (3.61% vs. 0.53%, 0.71%) than those in groups A and B, respectively (p < 0.0001). Univariate analysis revealed that familiarity was the more relevant independent variable associated with POI in poly-autoimmunity.

Our data strongly suggest that young women with thyroid-related poly-autoimmunity, born to a family with thyroid-related poly-autoimmunity, should have their ovarian reserve checked early to guide fertility preservation and family planning.