Clinical Correlation between Hyperandrogenism, Serum TSH Levels, and Hirsutism in Women: A Comparative Cross-Sectional Case-Control Study in Basrah, Iraq

الملخص

Background: Hirsutism is a common clinical sign of endocrine dysfunction in females.

Objective: This study aimed to investigate the association between serum Thyroid-Stimulating Hormone (TSH), Testosterone, DHEA-S levels and degree of hirsutism among Basrah women, Iraq.

Methods: The study included a total of 150 subjects (100 females with clinically confirmed hirsutism and 50 healthy controls). The severity of hirsutism was assessed by the Modified Ferriman-Gallwey (mFG) score. Serum TSH, Testosterone and DHEA-S were determined by using Electro-chemiluminescence immunoassay (ECLIA) technology. Endocrine tumors, congenital adrenal hyperplasia, Cushing’s syndrome and hormonal medications were exclusion criteria.

 Results: The hirsutism group had a significantly higher mFG score (17.5 ± 1.8 vs. 5.5 ± 1.5; P < 0·001), indicating that as follicular density increases, hirsutism scores rise accordingly. Patients with hirsutism had significantly higher levels of testosterone (P < 0.001) and DHEA-S (P = 0.002), as measured via hormonal analysis. Using correlation analysis, mFG scores were strongly positively associated with testosterone (r = 0.68; P < 0.001) and moderately positively correlated with DHEA-S (r = 0.48; P < 0.001). In particular, TSH had a weak inverse non-significant correlation with the severity of hirsutism (r = -0.14, P = 0.082).

Conclusion: Hirsutism in this population is driven by androgen excess rather than thyroid dysfunction. Assessment of the androgenic axis should be prioritized in diagnostic strategy: TSH assessment is an ancillary evaluation that should not be regarded as a first-line diagnostic for hirsutism.