Endocrine Abstracts

Objective: to evaluate the effects of metformin use on weight loss, improvement of ovarian and thyroid function in obese women with polycystic ovarian syndrome.

Material and Methods: 30 obese (BMI 30–34.99 kg/m²) hypothyroid (TSH 6–10 mIU/ml) women of age 25–35 years old were included. The patients received appropriate levothyroxine treatment according to TSH levels and body weight. A number of 15 patients added metformin gradually increased from a starting dose of 500 mg/day to a final dose of 3000 mg/day over a period of 6 months. Baseline levels, 3 months and 6 months levels of TSH, fT4, T3, AMH, LH/FSH ratio, testosterone, along with BMI and ultrasound ovarian volume and antral follicle count were determined. No adverse events that might have led to discontinuation of the treatment were recorded. Mild nausea was registered in 8 patients after 2 weeks of treatment with 3000 mg/day of metformin, respectively softer stools (but no diarrhoea) in 5 patients in the first week of treatment (500 mg/day), but the symptoms relieved with disappearing within the mentioned time frame.

Results: BMI levels decreased significantly in the first 3 months in metformin group (32.5+/-1.65 kg/m² vs. 28.4+/− 1.95 kg/m²). BMI variation in the non met-group was smaller. BMI levels have reached a plateau after 3 months of metformin treatment. TSH levels decreased (7.2+/− 1.6 mUI/ml vs. 4.8+/−2.2 mUI/ml) significantly in the metformin group, compared to a smaller decrease in the non-metformin group (5.6+/−2.2). Significant decrease was registered for the LH/FSH ratio (5,10+/−0.9 vs. 2,1+/−0.45), AMH (9.80+/−1.6 vs. 7.9+/ −1.2 ng/ml) and testosterone levels; antral follicle count and ovarian volume improved in met-group (in a similar fashion to the gross ultrasound appearance), while in non-met group, the 3 and 6 months values were similar to baseline.

Conclusion: Metformin treatment administered in high doses (3000 mg/day) on a 6 months period was useful for weight loss, improvement of ovarian function and decrease of androgen levels in obese PCOS patients with hypothyroidism. It also improved supplementary the thyroid function parameters. AMH can be used a prognostic marker for metformin response in PCOS obese patients with thyroid dysfunction, especially if (transvaginal) ultrasound scanning is not available.