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Is It Really PCOS?

Jul 21, 2025

Polycystic ovary syndrome (PCOS) and hypothyroidism are two common conditions of the hormonal (or endocrine) system that often occur in women in their reproductive years. Because of the overlap and similarities between their symptoms, it’s easy to be misdiagnosed and as a result receive improper or incomplete treatment. 

It is also very much possible for both of these conditions to coexist. A study published in the Journal of Clinical Endocrinology and Metabolism found that 34.4% of women with PCOS also had thyroid dysfunction.

However what I’ve been noticing is that often women get diagnosed with PCOS without doctors checking these patient’s thyroid function.

Hypothyroidism and PCOS share several symptoms, including menstrual irregularities, weight gain, and hyperandrogenism or elevated androgen levels (think acne, excess facial and body hair, thinning of scalp hair, infertility and more). 

Your thyroid gland plays a crucial role in regulating your metabolism, reproduction, and emotional well-being. And thyroid dysfunction, in this case hypothyroidism, can disrupt these functions, leading to symptoms similar to those experienced by women with PCOS. We now understand that thyroid disorders, even if subclinical, may contribute to the development of PCOS or at the least exacerbate their symptoms.

What can be helpful in distinguishing between these two conditions? 

It is not just one lab test, rather a combination of a thorough understanding of your health history and timeline of your symptoms, lab tests and imaging studies. 

Just running your TSH is *not* enough to diagnose a thyroid condition or to rule out a potential thyroid dysfunction. TSH (or thyroid stimulating hormone) is a hormone produced by your brain and it’s in charge of communicating to your thyroid gland to produce thyroid hormone. So, in addition to TSH, it’s crucial to run your actual thyroid hormones T3 and T4 (in their free form) as well as a couple of the common antibodies (Thyroid peroxidase and thyroglobulin antibodies). These antibodies can help you rule out a potential autoimmune thyroid disorder such as Hashimoto’s Thyroiditis. 

Something else worth keeping in mind is that although the presence of polycystic ovaries on ultrasound is a characteristic feature of PCOS, you do not have to have polycystic ovaries to have PCOS. 

Lastly, there are several other conditions, besides hypothyroidism, that can mimic PCOS symptoms such as non-classical congenital adrenal hyperplasia (NCCAH), hyperprolactinemia, androgen secreting tumors, Cushing’s syndrome and more. So if you suspect that you’re dealing with PCOS-type symptoms, it’s important to work with a doctor who is going to properly investigate the root cause(s) of your symptoms and address them holistically.