Reproductive Function in Thyroid Cancer Survivors: A Gender-Based Perspective on Outcomes

BACKGROUND: Thyroid cancer is one of the most common endocrine malignancies, with an excellent long-term survival rate. As survivorship increases, attention has shifted toward chronic endocrine sequelae, including disturbances of gonadal function and fertility. Thyroid cancer therapies, including thyroidectomy, long-term thyroid-stimulating hormone (TSH) suppressive therapy, radioiodine (RAI), and targeted systemic treatments, may interfere with reproductive health through complex endocrine and gonadal mechanisms. OBJECTIVE: This narrative review aims to examine the pathophysiological pathways linking thyroid cancer and its treatments to reproductive health in both men and women. RESULTS: Thyroidectomy and chronic TSH suppression may alter sex steroid bioavailability and gonadotropin regulation through changes in thyroid hormone signalling and sex hormone binding globulin synthesis. RAI therapy exerts dose-dependent gonadotoxic effects, particularly affecting ovarian reserve and spermatogenesis, often in a transient and reversible manner, but potentially accelerating reproductive aging and damage. Targeted therapies may also contribute to reproductive dysfunction, through indirect systemic and endocrine mechanisms; however, data on thyroid cancer patients are still limited. CONCLUSIONS: Thyroid cancer related reproductive dysfunction may arise from the interaction of endocrine, and treatment related mechanisms. Although often subclinical, these alterations are biologically relevant and may influence long-term fertility potential. An accurate counselling for fertility management in thyroid cancer survivors appears relevant and highlights areas for future research.