# Thyroid Function, Inflammation, and HDL-Cholesterol in Women with Acne: A Real-World Cross-Sectional Study Integrating Biochemistry and Thyroid Ultrasound

## TL;DR

This study finds that elevated thyroid-stimulating hormone (TSH) is strongly linked to low HDL-cholesterol in women with acne, independent of inflammation.

## Contribution

The paper integrates thyroid biochemistry, ultrasound, and metabolic markers in acne patients, revealing novel associations between TSH and HDL-C.

## Key findings

- High TSH is strongly associated with low HDL-cholesterol (OR 13.13) in women with acne.
- HDL-C levels inversely correlate with the neutrophil-to-lymphocyte ratio (NLR), indicating metabolic-inflammation interplay.
- Thyroid ultrasound metrics show limited correlation with thyroid biochemical markers in this population.

## Abstract

Background: Acne in adult women is increasingly recognized as a condition with systemic endocrine–metabolic correlates. Evidence linking acne to thyroid-related abnormalities and cardiometabolic risk markers remains mixed, and integrated real-world evaluations combining thyroid biochemistry, ultrasound metrics, inflammatory indices, and lipid profile are limited. Methods: We performed a cross-sectional observational analysis of 80 women with acne who underwent routine laboratory testing and thyroid ultrasound assessment. Thyroid status was defined using TSH (reference 0.4–4.5 mIU/L) and free T4 (0.8–1.8 ng/dL), with an additional TSH-only sensitivity definition (high TSH >4.5 mIU/L). Low HDL-cholesterol (HDL-C) was defined as <50 mg/dL. Group comparisons used Mann–Whitney U tests with Hodges–Lehmann shifts; associations were summarized using odds ratios (ORs) with Fisher’s exact tests; correlations used Spearman’s ρ (TSH log-transformed for correlation analyses) with confidence intervals. Multiple testing was controlled within panels using Benjamini–Hochberg FDR. Analyses were complete-case per comparison. Results: Thyroid dysfunction and metabolic–inflammatory abnormalities were common in this cohort. Low HDL-C was more frequent in thyroid dysfunction, and in the TSH-only sensitivity analysis, high TSH (>4.5 mIU/L) was strongly associated with low HDL-C (OR 13.13, 95% CI 1.48–116.04; p = 0.020). In a minimal adjusted model including NLR, high TSH remained associated with low HDL-C (adjusted OR 12.93, 95% CI 1.44–115.70; p = 0.022). HDL-C showed an inverse association with NLR (ρ = −0.28; p = 0.023). Endocrine profiling suggested a positive association between ACTH and log(TSH) (ρ = 0.62; p = 0.004), although this did not remain significant after FDR correction. Thyroid ultrasound metrics showed limited correspondence with thyroid biochemistry. Conclusions: In women with acne, elevated TSH is associated with substantially higher odds of low HDL-C, independent of inflammatory burden as proxied by NLR, while thyroid ultrasound morphology contributes limited functional information. These findings support integrated thyroid–metabolic assessment in adult female acne and motivate prospective studies incorporating acne severity measures and standardized testing to clarify clinical implications.