Hyperthyroidism and Erectile Dysfunction

A Population-Based Case-Control Study

J Keller; Y-K Chen; H-C Lin


Int J Impot Res. 2012;24(6):242-246. 

In This Article

Abstract and Introduction


Dysthyroidism has been highlighted as a common endocrine disorder associated with erectile dysfunction (ED); however, to date, no large-scale population-based study has investigated the association between hyperthyroidism and ED. This case–control study aimed to explore the association between ED and hyperthyroidism using a population-based data set. In total, 6310 adult patients who received new diagnoses of ED were recruited as cases together with 18 930 matched enrollees with no history of ED who served as controls. Conditional logistic regressions were conducted to explore the association between ED and having been previously diagnosed with hyperthyroidism. In total, 569 (2.3%) of the 25 240 sampled subjects had been diagnosed with hyperthyroidism before the index date; hyperthyroidism was found in 207 (3.3%) cases and 362 (1.90%) controls. After adjusting for potential confounding factors, the odds ratio (OR) of prior hyperthyroidism among cases was 1.64 (95% confidence interval=1.37–1.96, P<0.001) than that of controls. No association was detected between prior hyperthyroidism and ED for the 18–30, 30–39 and ≥70 age groups. Subjects aged between 60 and 69 years had the highest ORs for prior hyperthyroidism among cases when compared to controls (OR=1.84; 95% confidence interval=1.20–2.84; P<0.001). Our study further confirms the existence of an association between ED and prior hyperthyroidism.


Hyperthyroidism is a condition in which the thyroid produces an excessive amount of thyroid hormone[1] and affects approximately 2% of women, but significantly less in men.[2] A recently conducted prevalence study in Norway found that 0.9% of all Norwegian men over 20 years old in Nord-Trùndelag had been diagnosed with hyperthyroidism.[3] Graves' disease accounts for 70% of hyperthyroidism cases, with the age of onset most often occurring during young adulthood[1] and is a genetically linked autoimmune disorder in which the body produces antibodies to its own tissues, which in turn cause the thyroid to produce excess of thyroid hormone. The other 30% of hyperthyroidism cases result from other causes, such as toxic nodular goiters, subacute thyroiditis, exposure to iodine from medications or X-ray dyes and postpartum thyroiditis. Whether on account of autoimmune, inflammatory or metabolic sources,[1] the effects of hyperthyroidism have been reported to be associated with sexual impotence among men.[3,4] Furthermore, one recent study has demonstrated that thyroid hormone nuclear receptors in the penis provide the biological basis for the direct action of thyroid hormones on this organ and suggested that physicians should be advised to investigate sexual function in men with thyroid disorders.[5]

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse and is the most common sexual problem among aging male subjects.[6,7] The Massachusetts Male Aging Study reported that 52% of their community-based survey of men aged between 40 and 70 years old suffered from some degree of ED.[7] ED has been demonstrated to have a negative impact on intimate relationships, quality of life[8] and self-esteem.[9]

Although the etiology of ED is complex and understood to be the result of interplay between altered erectile nerve function, cognitive decline, illness-related stress and decreased interpersonal interaction,[10,11] both the pathology of ED and dysthyroidism have been highlighted as sharing common underlying endocrine dysfunction.[12] To date, few studies have investigated the association between dysthyroidism and ED, and all were either hospital-based studies or characterized by small case numbers. The pioneering study was conducted in Italy and included 34 men in a multicenter study in Italy,[4] while another study included 27 individuals suffering from hyperthyroidism selected from the thyroid outpatient clinic of one hospital in Greece.[13]