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

Abstract 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.