Sonographic Assessment of Ovarian Morphology and Thyroid Function in Nigerian Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and is characterized by reproductive, metabolic, and ovarian morphological abnormalities. Although thyroid dysfunction frequently coexists with PCOS, its influence on ovarian morphology remains unclear, particularly among African women.
Objective: To investigate the relationship between circulating thyroid hormone concentrations and sonographic ovarian morphological features among Nigerian women with PCOS.
Methods: This hospital-based prospective comparative cross-sectional study included 205 women aged 18–45 years recruited from the Department of Obstetrics and Gynaecology, Federal Medical Centre, Onitsha, Nigeria, between June 2025 and May 2026. Participants comprised 105 women diagnosed with PCOS according to the 2023 International Evidence-based Guideline (modified Rotterdam criteria) and 100 apparently healthy controls. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured using enzyme-linked immunosorbent assay. Transvaginal ultrasonography was performed to assess ovarian volume, stromal thickness, and antral follicle count (AFC). Differences between groups were analyzed using the independent-samples t-test, while Pearson’s correlation analysis assessed associations between thyroid hormone concentrations and ovarian morphological parameters. Statistical significance was set at p < 0.05.
Results: Women with PCOS showed significantly increased antral follicle count and ovarian stromal thickness compared with healthy controls (p < 0.001 for both parameters). Significant differences in ovarian morphological characteristics were observed between the groups. However, serum TSH, FT3, and FT4 concentrations demonstrated no significant correlations with ovarian volume, stromal thickness, or antral follicle count in either the PCOS or control groups (all p > 0.05).
Conclusion: Women with PCOS exhibit characteristic sonographic ovarian alterations, particularly increased antral follicle count and stromal thickness, which appear to occur independently of circulating thyroid hormone concentrations. These findings suggest that thyroid hormones may not play a major role in determining ovarian morphological changes in PCOS. Although thyroid function evaluation remains essential in the endocrine assessment of women with PCOS, transvaginal ultrasonography remains central to the evaluation of ovarian morphology. Further multicentre longitudinal studies incorporating broader endocrine and metabolic profiles are recommended to better define the interaction between thyroid function and ovarian changes in PCOS.

Polycystic ovary syndrome; thyroid-stimulating hormone; Antral Follicle Count; Ovarian Stromal Thickness; transvaginal ultrasonography.

1. Dason ES, Koshkina O, Chan C, Sobel M. (2024). Diagnosis and management of polycystic ovarian syndrome. Canadian Medical Association Journal (CMAJ), 196(3), E85–E94. https://doi.org/10.1503/cmaj.231251 [Google Scholar] [Crossref]

2. Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, Duhamel A, Catteau-Jonard S. (2011). Diagnosis of polycystic ovary syndrome (PCOS): Revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Human Reproduction, 26(11), 3123–3129. https://doi.org/10.1093/humrep/der297 [Google Scholar] [Crossref]

3. Dewailly, D., Lujan, M. E., Carmina, E., Cedars, M. I., Laven, J. J. E., Norman, R. J., & Escobar-Morreale, H. F. (2014). Definition and significance of polycystic ovarian morphology: A task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Human Reproduction Update, 20(3), 334–352. https://doi.org/10.1093/humupd/dmt061 [Google Scholar] [Crossref]

4. Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., Zoeller, R. T., & Gore, A. C. (2009). Endocrine-disrupting chemicals: An Endocrine Society scientific statement. Endocrine Reviews, 30(4), 293–342. https://doi.org/10.1210/er.2009-0002 [Google Scholar] [Crossref]

5. Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S. E., & Legro, R. S. (2021). Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocrine Reviews, 42(6), 538–583. https://doi.org/10.1210/endrev/bnab012 [Google Scholar] [Crossref]

6. Escobar-Morreale, H. F. (2023). Polycystic ovary syndrome: Definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 19, 270–290. [Google Scholar] [Crossref]

7. Ezugwu EE, Ugwu AC, Manafa PO, Ezugwu GI, Ogolodom MP. (2023). Effect of Body Mass Index on Ovulation in Nigerian Women with Polycystic Ovarian Syndrome Undergoing Treatment with Clomiphene Citrate: A Sonographic Study. International Journal of Applied Science and Research, 6(1). DOI: 10.56293/IJASR.2022.5490. [Google Scholar] [Crossref]

8. Hu, S., Yu, Q., & Zhang, Y. (2022). Association between thyroid dysfunction and polycystic ovary syndrome: Current evidence and clinical implications. Frontiers in Endocrinology, 13, Article 1006956. [Google Scholar] [Crossref]

9. Iwase, A., Hasegawa, Y., Tsukui, Y., Kobayashi, M., Hiraishi, H., Nakazato, T., & Kitahara, Y. (2023). Anti-Müllerian hormone beyond an ovarian reserve marker: The relationship with the physiology and pathology in the life-long follicle development. Frontiers in Endocrinology, 14, 1273966. https://doi.org/10.3389/fendo.2023.1273966 [Google Scholar] [Crossref]

10. Jonard, S., Robert, Y., Cortet-Rudelli, C., Pigny, P., Decanter, C., & Dewailly, D. (2003). Ultrasound examination of polycystic ovaries: Is it worth counting the follicles? Human Reproduction, 18(3), 598–603. https://doi.org/10.1093/humrep/deg115 [Google Scholar] [Crossref]

11. Liu, X., Xu, X., Li, J., et al. (2023). The reference value of anti-Müllerian hormone to diagnose polycystic ovary syndrome is inversely associated with BMI: A retrospective study. Reproductive Biology and Endocrinology, 21, 15. https://doi.org/10.1186/s12958-023-01064-y [Google Scholar] [Crossref]

12. Mancini, A., Bruno, C., Vergani, E., Di Segni, C., & Silvestrini, A. (2021). Thyroid hormones, oxidative stress, and reproduction. International Journal of Molecular Sciences, 22(16), 8753. [Google Scholar] [Crossref]

13. Pea J, Bryan J, Wan C, Oldfield AL, Ganga K, Carter FE, Johnson LM, Lujan ME. (2024). [Google Scholar] [Crossref]

14. Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: A systematic review and diagnostic meta-analysis. Human Reproduction Update, 30(1), 109–130. [Google Scholar] [Crossref]

15. https://doi.org/10.1093/humupd/dmad027 [Google Scholar] [Crossref]

16. Pereira-Eshraghi, C. F., Tao, R., Chiuzan, C. C., Zhang, Y., Shen, W., Lerner, J. P., Oberfield, S. E., & Sopher, A. B. (2022). Ovarian follicle count by magnetic resonance imaging is greater in adolescents and young adults with polycystic ovary syndrome than in controls. F&S Reports, 3(2), 102–109. https://doi.org/10.1016/j.xfre.2022.01.008 [Google Scholar] [Crossref]

17. Poppe, K., & Velkeniers, B. (2023). Thyroid and reproduction: A clinical update. Journal of Clinical Endocrinology & Metabolism, 108(4), 793–805. [Google Scholar] [Crossref]

18. Stener-Victorin E, Teede HJ, Norman RJ, Legro RS, Goodarzi MO, Dokras A, Laven J, Hoeger KM, Azziz R, Piltonen TT, et al. (2024). Polycystic ovary syndrome. Nature Reviews Disease Primers, 10, 27. https://doi.org/10.1038/s41572-024-00511-3 [Google Scholar] [Crossref]

19. Sumji, S., Bhat, A., Rashid, A., Bashir, R., Wani, I. A., Vasudevan, V., Sehar, T., & Ganie, M. A. (2023). Efficacy of serum anti-Müllerian hormone (AMH) levels for prediction of polycystic ovary syndrome (PCOS) and its association with clinical, biochemical and hormonal parameters. Indian Journal of Clinical Biochemistry, 38(4), 457–465. https://doi.org/10.1007/s12291-022-01058-4 [Google Scholar] [Crossref]

20. Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., & International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 120(4), 767–793. [Google Scholar] [Crossref]

21. World Health Organization (WHO). (2023). Endocrine disrupting chemicals. Geneva: World Health Organization. [Google Scholar] [Crossref]

22. Yuwen, T., Yang, Z., Cai, G., Feng, G., Liu, Q., & Fu, H. (2023). Association between serum anti-Müllerian hormone levels and IVF/ICSI outcomes in patients with polycystic ovary syndrome: A systematic review and meta-analysis. Reproductive Biology and Endocrinology, 21, 95. https://doi.org/10.1186/s12958-023-01153-y [Google Scholar] [Crossref]

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