The paper claims that thyroid hormone levels as well as female gonadal steroid levels are irregular in polycystic ovarian syndrome.  These hormones are in addition to the already established androgen and insulin concentrations abnormalities. 

The claim of abnormal gonadal steroids is not novel; the thyroid hormone abnormality is more novel. 

The hypothesis of the paper is weak; the author did not predict in which way the levels would be abnormal (high or low)  which I do believe he could have done from his introduction.

I thought jumping from PCOS symptomology to hypothyroidism was a bit of a stretch.  There was no string written link there.  It does not mean that link does not exist; it was not put into the introduction,

The evidence and numbers are strong and clear, but the sample number is low.  In addition I assume all his subjects were from the same ethnic (genetic) background.

There were no deviations.

The methods used commercially available kits, and proper statistics so the methods look valid.  The subjects were controlled well.  The sample number is small.

Needs to be replicated in larger population and in different ethnic groups.

It is a good simple paper that needs replication with larger sample sizes and in different ethnic groups.

NA

Experience in the actions of hormones. Taught classes in endocrinology.

This manuscript addresses an important issue of the relationship of the reproductive hormones and associated thyroid dysfunction in polycystic ovarian syndrome.  The findings described in the manuscript are interesting and possess publication for the better understanding of the etiology and management of polycystic ovarian syndrome.

This paper validates previously published paper in this area. Relationship among reproductive hormones and thyroid dysfunction with polycystic ovarian syndrome has been described elsewhere in literature as evidenced by PubMed search. However, addressing the following minor comments with corrections will benefit towards the betterment of the scientific approach of the manuscript and its readability to the relevant scientific community.

This claim is not novel. It validates previously publsihed papers by other authors. Ref: (1) doi:10.1155/2012/492803; (2) Eur J Endocrinol. 2004 Mar;150(3):363-9.

Previously published literature are not well compared and discussed with the context of present problem.

Results supports and validates previously published papers by other authors.

No deviation is noticed.

Experimental methodolgy and analyses are not described in detail so that other investigators can reproduce it.

Additional experiemnts to assay thyroixine binding proteins would have been beneficial to interprete the results better, but it is not needed to draw conclusion in the present paper.

This is not an outstanding paper. However its importance lies in its validation of previous reports and further investigation with more approriate research design is recommended.

Title: The title appropriately reflects the research performed.

Abstract: The abstract is nicely written. However, the following minor comments are provided below:

• Paragraph 1, line 7: “leutinizing” should be spelled correctly as “luteinizing”.
• Paragraph 1, line 10: “form” should be corrected as “from”

Introduction:

• Paragraph 1, line 4:
  • Authors are defining polycystic ovaries and mentioning measurement of ovaries as 2 mm. Is this 2 mm size describing the diameter or the radius of the size of the ovaries? It is not clear. Inclusion of this information would be beneficial to understand it better.
  • Paragraph 1, line 7:
    • Authors mentions about the “cycle”. It is understood that it is “reproductive cycle”. However, mentioning this would clarify this in a better manner to the readers.
    • Along with TBG, TBPA, and albumin thyroid hormones are also bound to transthyretin in blood. Plasma concentrations of transthyretin are actually higher than TBG or TBPA. This additional information would be helpful to the readers.
    • According to the goal of this article inclusion of some background information about the reproductive hormones also would enrich this section. It is only emphasizing about thyroid hormones.
    • At the end of the “introduction” section this intends to study thyroid hormone profiles. However, intention of this article to measure also the reproductive hormones and indeed reproductive hormones were measured and tabulated as data. Hence, the authors should also mention about the assay of reproductive hormones along with thyroid hormones. This information in this section is lacking.

Methods:

• Paragraph 2, line 11: Correctly check the spelling for the word “leutinising”.

Results:

• Results of the hormone levels are shown in table 1. However changes in the levels of the hormones have not been described in the results section and should have been described in detail in this section. Some data for the reproductive hormone levels are not in consistent with previously published data by other authors. This inconsistency has not been discussed in this manuscript (ref: doi:10.1155/2012/492803).

Discussion:

• Paragraph 1 describes the results of the levels of hormones. This portion should preferably be included in the result section. This section is expected to discuss the results obtained with relevant references and explain.
• Data on BMI is shown and described in the result section and in table 1. However, this data has not been discussed.
• Paragraph 2, line 3 is describing the mechanism of LH. It writes, “LH penetrates the follicle…..” LH is a peptide hormone and it has transmembrane receptors localized in the plasma membrane of the cells. It does not penetrate the cell. This information should be corrected.
• Paragraph 2: Incorporation of a brief explanation of why high TSH levels could lead to underactive thyroid gland producing low T3 and T4 would be important. A discussion about autoimmune thyroiditis is important in this context.
• Discussion is also needed for possible effect of low levels of progesterone. This has not been discussed in the manuscript.

Thyroid Endocrinology

The opening statement that the symptoms of PCOS and Hypothyroidism resemble each other is incorrect. Hypothyroid patients do not have acne, anemia, oligomenorrhea (rather they have menorrhagia more often). They also have cold intolerance, decreased sweating, slow response, hoarse voice, constipation and hung up reflexes in advanced cases. Agreed both are overweight or obese but the disorders are different.

No.

NA

The authors claim that the patients of PCOS were found to be suffering form hypothyroidism as was evident by increased TSH and decreased free and total T3 and T4 levels. However the Results are not in detail at all. How many patients had subclinical hypothyroidism, and how many had hypothyroidism is not shown in the only table shown. The Abstract says “…patients of PCOS were found to be suffering form hypothyroidism…” The statement presumes that all fifty patients having PCOS had hypothyroidism! Demonstrating that more patients who had PCOS had hypothyroidism than the controls would be better data than showing the mean of FT3, FT4 and TSH.

NA

No. The only chart is incomplete in the data provided. Many details are missing.

Yes. The details about the cases studied would enhance the paper's credibility and the results would be worth appreciating. The authors would have the details and a couple of more tables would have done the trick.

No. It has nothing new to offer due to the many fallacies.

The Conclusion that  “….may help in better understanding of the etiology and management of PCOS” is misleading. Instead the more appropriate recommendation would be that since the two diseases coexist more often than by chance, all patients having PCOS should be subjected to analysis of thyroid profile so that this common treatable disorder is not missed and treated in time. Otherwise even after treatment of PCOS, many patients may not conceive and the underlying reason may be hypothyroidism as it itself is a common cause of infertility.

Hypothyroidism is very common in the iodine deficient state of Kashmir and we see many cases of this disease on a daily basis. Also I am a life member of the Indian Thyroid Society.