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Effects of oral contraceptives on thyroid function and vice versa

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Abstract

Background

Thyroid gland dysfunction represents an epidemiologically relevant disease in the female gender, where treatment with oral contraceptives (OCs) is frequently prescribed. Although OCs are able to impact the thyroid gland function, scanty data have been released on this matter so far.

Aim

The aim of this article was to review how hormonal OCs, including estrogen- or progesterone-only containing medications, interact with the hepatic production of thyroid-binding globulin (TBG) and, consequently, their effects on serum levels of thyroxine (T4) and triiodothyronine (T3). We also reviewed the effect of Levo-T4 (LT4) administration in women taking OCs and how they influence the thyroid function in both euthyroid women and in those receiving LT4.

Review

The estrogenic component of the pills is capable of increasing various liver proteins, such as TBG, sex hormone-binding protein (SHBG) and coagulation factors. On the other hand, the role of progestogens is to modulate estrogen-dependent effects mainly through their anti-androgenic action. In fact, a reduction in the effects of androgens is useful to keep the thromboembolic and cardiovascular risks low, whereas OCs increase it especially in women with subclinical hypothyroidism or in those treated with LT4. Accordingly, subclinical hypothyroidism is known to be associated with a higher mean platelet volume than normal and this increases cardiovascular risk due to platelet hyperactivity caused by incomplete thrombocytopoietic maturation.

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Abbreviations

APC:

Active protein c

CVD:

Cardiovascular disease

OC:

Oral contraceptive

DNG:

Dienogest

EE:

Ethinyl estradiol

EV:

Estradiol valerate

FT4:

Free thyroxine

FT3:

Free triiodothyronine

LNG:

Levonorgestrel

LT4:

Levothyroxine

MI:

Myocardial infarction

MPV:

Mean platelet volume

PDW:

Amplitude of platelet distribution

PLT:

Platelet count

T3:

Triiodothyronine

T4:

Thyroxine

TSH:

Thyroid-stimulating hormone

TRH:

Thyrotropin-releasing hormone

TBG:

Thyroxine-binding globulin

TG:

Triglycerides

TTR:

Transthyretin

SCH:

Subclinical hypothyroidism

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy

    F. Torre, A. E. Calogero, R. A. Condorelli, R. Cannarella & S. La Vignera

  2. Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy

    A. Aversa

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  1. F. Torre
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Torre, F., Calogero, A.E., Condorelli, R.A. et al. Effects of oral contraceptives on thyroid function and vice versa. J Endocrinol Invest 43, 1181–1188 (2020). https://doi.org/10.1007/s40618-020-01230-8

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