Background: Polycystic Ovarian Syndrome (PCOS) is a major endocrine disorder in reproductive age women. PCOS is associated with insulin resistance. Some of the PCOS women also have thyroid dysfunction. There are variable and controversial findings regarding the association of thyroid stimulating hormone with insulin resistance. The objective of our study was to analyze the relation between thyroid stimulation hormone with insulin resistance in patients with PCOS. Methods: The case control study was carried out on 216 reproductive age women with PCOS. Insulin resistance was measured by Homeostatic model assessment of insulin resistance (HOMA-IR) and those with HOMA-IR more than 1.9 were defined as having insulin resistance. PCOS women with insulin resistance were cases (n=108) and those without insulin resistance were controls (n=108). Thyroid stimulating hormone (TSH) levels was assessed in both groups.Association of thyroid stimulating hormone with insulin resistance was analyzed. Result: The mean serum TSH level was significantly more in insulin resistant PCOS women (3.87±3.44 mIU/L) than those without insulin resistance (2.29±1.66 mIU/L). Hypothyroidism (TSH >2.5 mIU/L) were present in 63.9% of insulin resistant PCOS women compared to 31.3% of those without insulin resistance. The odds of hypothyroidism (TSH level >2.5 mIU/L) was 4.19 times more in insulin resistant PCOS women. Conclusion: There is significant positive association of hypothyroidism with insulin resistance in PCOS.