Primary thyroid dysfunction and changes in the gonadal axis and SHBG in adult men: a prospective cohort study.

IF 4.9 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

European Thyroid Journal Pub Date : 2026-10-01 DOI:10.1530/ETJ-26-0111

Reinier Petrus van Otzel, Stien Somers, Nick Narinx, Jennifer Nyamaah, Leen Antonio, Dirk Vanderschueren, Sandra Nuyts, Karel David, Brigitte Decallonne

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引用次数: 0

Abstract

Objective: Thyroid dysfunction modulates the hypothalamic-pituitary-gonadal axis in men, potentially altering sex hormone bioavailability. Prior studies relied on immunoassays for the measurement of sex steroids. We investigated the effect of primary thyroid dysfunction on testosterone (T) and estradiol (E2) in men, using high-specificity liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Methods: In this prospective cohort study, adult men with newly diagnosed hyperthyroidism or hypothyroidism were evaluated at diagnosis and at the first follow-up visit. Changes in serum markers of gonadal function were assessed: follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), total and calculated free testosterone, total estradiol, and total testosterone:estradiol (T:E2) ratio.

Results: Sixteen men with hyperthyroidism and eleven with hypothyroidism were included. In the hyperthyroid cohort, total T, total E2, and SHBG levels decreased during treatment (P = 0.0131, P = 0.0063, and P = 0.0003), while free T, total T:E2 ratio, FSH, LH, and prolactin remained unchanged. In the hypothyroid cohort, increased SHBG, LH, and FSH levels were observed during levothyroxine treatment (P = 0.0014, P = 0.0117, and P = 0.0039), while total and free T, total E2, and prolactin remained unchanged. In the subgroup with overt hypothyroidism, the total T:E2 ratio increased during levothyroxine treatment.

Conclusion: In hyperthyroid males during treatment, short-term changes in the gonadal axis are mainly mediated by reduced SHBG, without changes in free T, gonadotropins, or T:E2 ratio. In hypothyroid males, SHBG and gonadotropins increased under levothyroxine supplementation. These findings highlight the importance of assessing SHBG when evaluating the male gonadal axis during thyroid dysfunction.

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成年男性原发性甲状腺功能障碍和性腺轴及SHBG的变化：一项前瞻性队列研究。

目的：甲状腺功能障碍调节男性下丘脑-垂体-性腺轴，可能改变性激素的生物利用度。先前的研究依赖于免疫分析法来测量性类固醇。我们研究了原发性甲状腺功能障碍对男性睾酮(T)和雌二醇（E2）的影响，采用高特异性液相色谱-串联质谱（LC-MS/MS）。方法：在这项前瞻性队列研究中，对新诊断为甲状腺功能亢进或甲状腺功能减退的成年男性在诊断和首次随访时进行评估。评估血清性腺功能指标的变化：促卵泡激素（FSH）、促黄体生成素（LH）、催乳素、性激素结合球蛋白（SHBG）、总睾酮和计算游离睾酮、总雌二醇、总睾酮：雌二醇（T:E2）比值。结果：纳入16例甲亢患者和11例甲减患者。在甲状腺功能旺盛的队列中，治疗期间总T、总E2和SHBG水平下降（p=0.0131、p=0.0063和p=0.0003），而游离T、总T:E2比值、FSH、LH和催乳素保持不变。在甲状腺功能低下队列中，左旋甲状腺素治疗期间SHBG、LH和FSH水平升高（p=0.0014、p=0.0117和p=0.0039），而总T和游离T、总E2和催乳素保持不变。在明显甲状腺功能减退亚组中，总T:E2比值在左旋甲状腺素治疗期间升高。结论：在治疗期间，甲状腺功能亢进的男性，性腺轴的短期变化主要是由SHBG降低介导的，而游离T、促性腺激素和T:E2比值没有变化。在甲状腺功能低下的男性中，补充左甲状腺素后SHBG和促性腺激素均增加。这些发现强调了在评估甲状腺功能障碍期间男性性腺轴时评估SHBG的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.70

自引率

2.10%

发文量

156

期刊介绍： The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.