Sex differences in thyroid function: from central regulation to hormone metabolism and disease susceptibility

Sexual dimorphism in endocrinology refers to the biological differences between males and females in hormone production, secretion, metabolism, and action, shaped by genetic, epigenetic, and hormonal influences. These differences are fundamental to thyroid physiology and disease, affecting regulatory pathways from central hypothalamic-pituitary control to peripheral hormone metabolism. Clinically, women have a higher prevalence of autoimmune thyroid diseases, nodules, and differentiated thyroid cancer, while men more often present with advanced and aggressive disease. In this review, we integrate current evidence on sexual dimorphism in thyroid function, spanning from central regulation through the hypothalamic-pituitary-thyroid axis to thyroid hormones biosynthesis and peripheral metabolism, and discuss how these differences influence disease susceptibility and progression.