From the Guidelines
Chronic hyperthyroidism is indeed related to erectile dysfunction (ED), as it affects the endocrine system and disrupts hormonal balance necessary for normal sexual function. Men with untreated hyperthyroidism often experience decreased libido, erectile problems, and premature ejaculation due to the condition's impact on testosterone metabolism, sex hormone-binding globulin levels, and prolactin levels 1.
Key Factors to Consider
- Hyperthyroidism can lead to decreased cardiac contractility, low cardiac output, and symptoms of heart failure, which may indirectly contribute to ED 1.
- The condition may also cause vascular changes, leading to erectile dysfunction, and conversely, ED may be a precursor to cardiovascular disease (CVD) 1.
- Treatment of underlying hyperthyroidism typically improves sexual function in most patients, and may involve medications like methimazole or propylthiouracil, radioactive iodine therapy, or thyroid surgery.
Management of ED in Hyperthyroidism
- Patients with hyperthyroidism and ED should undergo a comprehensive evaluation, including medical, sexual, and psychosocial history, physical examination, and selective laboratory testing 1.
- Validated questionnaires, such as the Erection Hardness Score and the Sexual Health Inventory for Men, may be used to assess the severity of ED and guide treatment 1.
- During treatment, some patients may temporarily benefit from ED medications like sildenafil or tadalafil while thyroid levels normalize 1.
Importance of Monitoring and Treatment
- Regular monitoring of thyroid function through blood tests is essential during treatment, as achieving euthyroid status is crucial for resolving hyperthyroidism-related ED.
- Patients with cardiovascular disease and ED should be managed according to their cardiovascular risk factors, and those at high risk should not receive treatment for sexual dysfunction until their cardiac condition has stabilized 1.
From the Research
Relationship Between Chronic Hyperthyroidism and Erectile Dysfunction
- Chronic hyperthyroidism has been linked to an increased risk of erectile dysfunction (ED) in several studies 2, 3, 4.
- The underlying mechanism of this relationship may be related to the dysfunction of the hypothalamus-pituitary-thyroid axis, dysregulation of sex hormones, abnormal expression of thyroid hormone receptors, and psychiatric or psychological disturbances such as depression, anxiety, and irritability 3.
- Studies have shown that the prevalence of ED in patients with hyperthyroidism ranges from 3.05% to 85%, which is higher than the prevalence of ED in the general population (2.16% to 33.8%) 3.
- Treatment of hyperthyroidism has been shown to improve erectile function in patients with ED, suggesting that thyroid hormone disorders may be a reversible cause of ED 2, 4, 5.
Clinical Implications
- Screening for thyroid dysfunction should be performed in all men with ED, as treating thyroid dysfunction may be an effective way to improve erectile function in men with these health problems 2.
- The use of 5-phosphodiesterase inhibitors, such as sildenafil, tadalafil, and vardenafil, may be effective in treating ED in patients with hyperthyroidism, but the choice of treatment should be individualized based on the patient's profile and medical history 6.
- Normalization of thyroid hormone levels has been shown to improve sexual dysfunctions, including ED, in patients with hyperthyroidism and hypothyroidism 5.
Study Findings
- A study published in the Journal of Neuroendocrinology Letters found that treatment of thyroid dysfunction and 5-phosphodiesterase inhibitors improved erectile function in patients with hyperthyroidism and hypothyroidism 2.
- A review published in the Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae found that overt hyperthyroidism is significantly associated with an increased risk of ED 3.
- A study published in the International Journal of Andrology found that suppressed TSH levels were associated with ED, and overt hyperthyroidism was associated with an increased risk of severe ED 4.
- A multicenter study published in The Journal of Clinical Endocrinology and Metabolism found that most patients with thyroid hormone disorders experience some sexual dysfunctions, which can be reversed by normalizing thyroid hormone levels 5.