{"paper_id":"2140c334-062f-462a-a354-9b2c6c0e7bbd","body_text":"e INTRODUCTION\nThe relevance of this study lies in the high prevalence of \nendocrine disorders among women of reproductive age \nand their close association with endometrial pathology. \nThyroid dysfunction can influence the menstrual cycle, \nfertility, and the morphofunctional state of the endome -\ntrium, thereby complicating the course of gynaecological \nconditions. Investigating the relationship between these \ndisorders is essential for early diagnosis, the selection of \nSuggested Citation:\nGanzhiy I, Sokolovska I.  Thyroid status in patients with endometrial pathology. Bull Med Biol Res. 2025;7(2):49–59. DOI: 10.63341/\nbmbr/2.2025.49\n*Corresponding author\nUDC 616.441:618.14\nThyroid status in patients with endometrial pathology\nIryna Ganzhiy\nDoctor of Medical Sciences, Professor\nZaporizhzhia State Medical and Pharmaceutical University\n69035, 26 Maria Prymachenko Blvd., Zaporizhzhia, Ukraine\nhttps://orcid.org/0009-0008-2490-5222\nIryna Sokolovska*\nPhD in Medical Sciences, Assistant\nZaporizhzhia State Medical and Pharmaceutical University\n69035, 26 Maria Prymachenko Blvd., Zaporizhzhia, Ukraine\nhttps://orcid.org/0009-0008-2487-1675\nAbstract. The aim of this study was to investigate the functional status of the thyroid gland in women with endometrial \nhyperplastic processes, in light of the increasing interest in the role of thyroid dysfunction in the aetiopathogenesis of \nproliferative changes in the uterine mucosa. The study included 30 women of late reproductive and perimenopausal age \n(14-50 years), diagnosed with various forms of endometrial hyperplastic pathology, based at the Zaporizhzhia Medical \nAcademy of Postgraduate Education, Ministry of Health of Ukraine. The methodology involved clinical and laboratory \nassessment of patients, including pelvic ultrasound, histological examination of the endometrium, and evaluation of \nthyroid-stimulating hormone, free thyroxine and triiodothyronine levels, along with antibodies to thyroid peroxidase. \nThe main findings demonstrated that women with endometrial hyperplasia frequently exhibited concomitant \nthyroid dysfunction, including subclinical or overt hypothyroidism. An elevated thyroid-stimulating hormone level \n(3.8  ±  1.2  mIU/L) was observed in patients with endometrial hyperplasia compared to the control group, alongside \nincreased concentrations of thyroid peroxidase antibodies, indicating an autoimmune origin of the dysfunction. Analysis \nrevealed a correlation between the severity of thyroid dysfunction and the morphological variant of hyperplastic \nendometrial changes: clinically significant thyroid dysfunction was more prevalent in women with atypical hyperplasia. \nThese findings support the rationale for routine thyroid function screening in women with endometrial hyperplasia, \nto detect latent thyroid pathology, which may serve as both a background and a triggering factor in the development \nof proliferative endometrial disorders. Thus, the study underscores the importance of an integrated approach to the \ndiagnosis and management of endometrial hyperplastic processes, considering the status of the thyroid gland and the \nendocrine system more broadly\nKeywords: thyroid-stimulating hormone; menopause; thyroid dysfunction; thyroid peroxidase antibodies; tissue \nhyperplasia; reproductive age\nCopyright © The Author(s). This is an open access article distributed under the terms of the \nCreative Commons Attribution License 4.0 (https://creativecommons.org/licenses/by/4.0/)\nappropriate therapy, and the prevention of complications, \nwhile also enhancing the effectiveness of comprehensive \nmedical support for women.\n Among the various disorders of the female reproduc -\ntive system that are of interest to both clinical practice \nand scientific research, endometrial hyperplastic process -\nes warrant particular attention. Yu.V.  Strakhovetska  [1] \nand M. Al-Kaabi  et al. [2] examined the characteristics of  \nJournal homepage: https://bmbr.com.ua/enDOI: 10.63341/bmbr/2.2025.49\nArticle’s History: Received: 03.01.2025; Revised: 21.04.2025; Accepted: 27.05.2025\nBulletin of Medical  Bulletin of Medical  \nand Biological Researchand Biological Research\nVol. 7, No. 2 Vol. 7, No. 2 \n20252025\n\n\nThyroid status in patients with endometrial pathology\n5050\nBulletin of Medical and Biological Research. 2025. Vol.7, No.2\nDiscussion of thyroid dysfunction in patients with en-\ndometrial hyperplasia gains particular importance in the \ncontext of gynaecological and oncological disease pre -\nvention. Given the potential for proliferative endometrial \nchanges to undergo malignant transformation, timely cor-\nrection of concomitant endocrine disorders, especially thy-\nroid dysfunction, may serve as a valuable secondary pre -\nventive strategy against oncological complications. This \nis especially pertinent in high-risk populations, including \nwomen in perimenopause, those with excess body weight, \nmetabolic syndrome, or a family history of related diseas -\nes. D.Yu.  Beraya  [8] observed that women with infertility \nand various thyroid pathologies frequently present with \novarian-menstrual disorders such as dysmenorrhoea and \noligomenorrhoea. In cases of infertility, the predominant \ncontributing factor is endometriosis in patients without \nthyroid pathology, whereas in those with thyroid dysfunc -\ntion, the endocrine factor is more relevant.\nEndometrial hyperplastic processes are common \namong women of late reproductive and perimenopausal age \nand are associated with a high risk of recurrence and ma -\nlignancy. J. Huang et al. [9] have described oncological var-\niants of endometrial pathology and the associated risk fac-\ntors. Nevertheless, the role of thyroid dysfunction in these \nprocesses remains insufficiently understood, and current \nclinical protocols do not mandate thyroid function assess -\nment. This represents a significant scientific and practical \ngap, which hampers the timely identification of concomi -\ntant endocrine abnormalities and reduces the effectiveness \nof therapeutic interventions. Aim of the study: to assess the \nfunctional state of the thyroid gland in women with endo -\nmetrial hyperplastic processes and to establish a potential \npathogenetic link. Objectives of the study: to determine \nthe prevalence of thyroid pathology among patients with \nendometrial hyperplastic processes; to analyse the levels \nof thyroid-stimulating hormone (TSH), free triiodothyro -\nnine (T3), free thyroxine (T4), and antibodies to thyroid \nperoxidase; to identify correlations between the forms \nof endometrial hyperplasia and thyroid function status.\ne MATERIALS AND METHODS\nDuring the study, 60 women aged 14 to 50 years with endo-\nmetrial hyperplastic processes were examined. The average \nbody weight of the patients was 65 kilograms. Two groups \nwere formed: the second group served as the control group \nand comprised 30 women, also aged 14 to 50 years and \nweighing approximately 65 kg. The inclusion criteria were \nthe presence of diagnosed hyperplastic changes in the en -\ndometrium, absence of malignant neoplasms, and informed \nconsent to participate in the study. The exclusion criteria \nincluded severe somatic diseases, pregnancy, oncological \npathology, and refusal to participate. The control group \nconsisted of women without gynaecological pathology.\nAll participants underwent a detailed collection of gy-\nnaecological, reproductive, and somatic history, as well as \nclinical, laboratory, and instrumental examinations. The \nstudy was conducted at the Zaporizhzhia Medical Acade -\nmy of Postgraduate Education of the Ministry of Health of \nUkraine, from 1 June 2023 to 1 June 2024. All participants \nsigned informed consent forms, which outlined the pur -\npose, methods, and potential risks of the study, and guar -\nanteed confidentiality of personal data and medical results. \nendometrial hyperplastic processes in postmenopausal \nwomen, noting that the majority of patients (77%) pre -\nsented with climacteric syndrome during the menopausal \ntransition. In 60% of these women, certain manifestations \nof the syndrome persisted into the postmenopausal period. \nThese pathologies encompass a broad spectrum of altera -\ntions in the uterine mucosa, ranging from benign prolifer -\native changes to precancerous conditions and early-stage \ncarcinoma. O.D. Leshchova [3] observed that gynaecological \npathology most frequently occurred in women with simple \nendometrial hyperplasia without atypia, often accompanied \nby chronic endometritis, as well as in patients with chron -\nic endometritis and reactive hyperplasia. Such cases were \ntypically associated with urogenital infections, menstru -\nal irregularities, and pronounced urinary tract pathology.\nDespite numerous studies, the pathogenesis of endo -\nmetrial hyperplastic processes remains complex and insuf-\nficiently understood. Hormonal imbalance  – particularly \noestrogen stimulation in the context of relative or absolute \nprogesterone deficiency, frequently observed in anovula -\ntory cycles – plays a significant role in the development \nof these changes. I.K. Orishchak  et al. [4] emphasised the \nimportance of infectious factors in the aetiology of endo -\nmetrial hyperplastic processes. Restoration of the genital \ntract microbiocenosis contributes to more effective treat -\nment and the prevention of relapses. Thyroid hormones \nparticipate in the regulation of the menstrual cycle, ovu -\nlation, endometrial development, and the maintenance of \npregnancy. Thus, changes in thyroid function may direct -\nly or indirectly impact the condition of the uterine lining. \nI.I. Kulyk & S.V. Khmil [5] noted that correcting endocrine \nimbalance, particularly through the use of vitamin D3 and \ninositol, has a positive effect on the endometrium in hor -\nmonally dependent conditions.\nThere is, however, a well-established association be -\ntween thyroid pathology and various gynaecological dis -\norders, including infertility, dysfunctional uterine bleed -\ning, polycystic ovary syndrome, and early menopause. The \npotential role of thyroid dysfunction in the pathogenesis \nof endometrial hyperplastic changes is of particular in -\nterest. Hypothyroidism – both subclinical and overt – may \nbe accompanied by anovulation, hyperoestrogenism, and \ndelayed secretory transformation of the endometrium, \nthereby creating conditions conducive to excessive prolif -\neration of the uterine lining. G.  Brenta & U.  Hostalek  [6] \nstudied comorbidities associated with hypothyroidism. \nAutoimmune thyroiditis, one of the most common caus -\nes of hypothyroidism, may also exert additional effects via \nsystemic inflammation and impaired immune regulation. \nL.J. Jara  et al. [7] have explored the broader systemic im -\npact of this disease in more detail. Despite the apparent \npathophysiological connections, the association between \nthyroid status and endometrial hyperplasia remains in -\nconsistently addressed in the literature. Some studies re -\nport a high frequency of thyroid abnormalities in patients \nwith endometrial hyperplasia, while others do not identify \nsignificant differences relative to the general population. \nThis discrepancy may be attributed to methodological var-\niations across studies – such as differing designs, inclusion \ncriteria, and classification of hyperplasia – as well as re -\ngional differences in thyroid disorder prevalence, iodine \nsufficiency, and socio-genetic factors.\n\nI. Ganzhiy and I. Sokolovska\n5151\nBulletin of Medical and Biological Research. 2025. Vol.7, No. 2\nThe study was conducted in accordance with the ethical \nstandards of the Declaration of Helsinki and was approved \nby the local ethics committee [10]. Specifically, information \nwas gathered on the regularity of the menstrual cycle, the \npresence of pathological bleeding such as menorrhagia or \nintermenstrual bleeding, and a history of gynaecological \ndiseases, including chronic inflammatory processes of the \npelvic organs, endometrial polyps, and uterine fibroids. \nThis information was obtained through patient interviews \nduring the study.\nAdditionally, data were collected on previous pregnan-\ncies, childbirths, abortions and any related complications, \nthe use of contraceptives and their effect on the menstru -\nal cycle. Reproductive history included assessment of the \nnumber of pregnancies, deliveries, and abortions, as well \nas potential fertility issues or miscarriages, and the use of \novulation-stimulating medications. The presence of syn -\ndromes that could affect reproductive function, such as \npolycystic ovary syndrome, was also assessed. The somat -\nic history enabled the collection of information regarding \nchronic diseases such as hypertension, diabetes mellitus, \ncardiovascular conditions, hepatic and renal disorders, as \nwell as the presence of endocrine abnormalities, particu -\nlarly hypothyroidism or autoimmune thyroid diseases. \nData concerning body weight, obesity, and lifestyle fac -\ntors  – including nutrition, physical activity, and harmful \nhabits such as smoking or alcohol consumption – were also \nrecorded. In addition, the patients underwent a clinical ex-\namination, which included a general physical assessment, \nblood pressure measurement, and evaluation of the genital \norgans via gynaecological examination, abdominal palpa -\ntion, and cervical inspection.\nLaboratory testing was conducted once, in the early \nmorning hours (07:00-08:00), on an empty stomach, tak -\ning into account diurnal hormonal fluctuations. Levels of \nthyroid-stimulating hormone (TSH), triiodothyronine (T3), \nthyroxine (T4), and antibodies to thyroid peroxidase, as \nwell as oestrogens, progesterone, follicle-stimulating hor -\nmone (FSH), and luteinising hormone (LH), were measured \nusing enzyme-linked immunosorbent assay (ELISA) and \nchemiluminescent immunoassay on the Cobas e411 auto -\nmatic analyser (Roche Diagnostics, Switzerland).\nA complete blood count and urinalysis were carried out \nusing haematological and automatic biochemical analys -\ners, respectively. Blood glucose levels were determined \nusing the glucose oxidase reaction method. To detect po -\ntential infectious agents influencing endometrial status, \nbacteriological cultures and cytological smear examina -\ntions were performed. Instrumental diagnostics included \npelvic ultrasound to assess the condition of the uterus and \novaries, and to identify any tumorous formations or anom-\nalies. For more detailed endometrial assessment, hyster -\noscopy was employed, and where necessary, endometrial \nbiopsy was performed for histological tissue analysis. This \ncomprehensive approach enabled evaluation not only of \ngynaecological status but also of thyroid function, and fa -\ncilitated the detection of comorbidities potentially influ -\nencing the course of endometrial hyperplastic processes. \nMorphological findings were interpreted according to the \nWorld Health Organization (WHO) classification [11].\nThe detection of antibodies to thyroid peroxidase \nsuggested a possible autoimmune origin of the disorders, \nwhich is particularly relevant in patients with gynaecolog-\nical pathology. Measurement of thyroglobulin levels fur -\nther contributed to the evaluation of thyroid function and \nstructure, especially when destructive thyroid processes \nwere suspected. This methodology allowed for the iden -\ntification of both hypo- and hyperthyroid states, which is \nessential for understanding the role of thyroid dysfunction \nin the development of endometrial proliferative processes. \nStatistical data analysis was performed using variational \nstatistics in the Excel software package. Differences were \nconsidered statistically significant at p  < 0.05. Descriptive \nstatistics, expressed as mean ± standard deviation, were ap-\nplied to characterise both parametric and non-parametric \ndata appropriately.\ne RESULTS AND DISCUSSION\nDuring the survey, it was established that the vast majority \nof patients – 90% – resided in urban areas, and approxi -\nmately half (53.33%) were employed in the service sector or \nengaged in intellectual work (i.e. white-collar occupations) \n(Fig. 1). Only one patient (3.33%) reported exposure to oc-\ncupational hazards in the workplace.\nFigure 1. Distribution of examined patients  \nby employment status\nSource: created by the authors\nBased on the data presented in Figure 1, it can be not-\ned that the majority of women were white-collar work -\ners, indicating a predominance of individuals engaged in \nsedentary or office-based occupations. Housewives and \nthose involved in physical or other forms of active labour \ncomprised a smaller proportion. This distribution may be \nrelevant when analysing risk factors associated with life -\nstyle and levels of physical activity. Analysis of menstrual \nfunction revealed that the average age at menarche among \npatients was 12.27   ±  1.04 years. At the time of examina -\ntion, only 4 women (13.33%) had regular menstrual cycles, \nwhile the majority of patients (80%) experienced heavy \nmenstrual bleeding. Within the gynaecological history of \nwomen with endometrial hyperplastic processes, the most \nfrequently associated diagnosis was uterine leiomyoma, \nobserved in 63.33% of cases (Fig. 2).\nFigure  2 illustrated the structure of concomitant gy -\nnaecological diseases in women with endometrial hyper -\nplastic processes. The most prevalent pathology was sal -\npingo-oophoritis, diagnosed in over 30% of cases. This was \nfollowed in frequency by endometrial hyperplasia, adeno -\nmyosis, cervical or uterine corpus pathology, and dysfunc-\ntional uterine bleeding. Ovarian cysts were less commonly \nobserved. These findings highlighted a high incidence of \nchronic inflammatory and proliferative changes within the \nreproductive system among the study group. It is note -\nworthy that the average duration of uterine leiomyoma in  \n30\n16.67\n53.33\nHousemakers\nWorkers\nEmployees\n\nThyroid status in patients with endometrial pathology\n5252\nBulletin of Medical and Biological Research. 2025. Vol.7, No.2\npatients was 3.61 ± 0.75 years, while endometrial hyperpla-\nsia had been diagnosed in five women approximately three \nyears prior to the current assessment. Menometrorrhagia \n(prolonged and heavy menstrual bleeding) was reported to \nhave begun, on average, 2.32  ± 0.16 years before the study \n(range: 0.5 to 8 years). The most frequently performed sur-\ngical intervention on the reproductive system among those \nexamined was separate diagnostic curettage of the uterine \ncavity, which had been undertaken in 23.33% of women. \nTwo patients had previously undergone adnexectomy, and \none had undergone cystectomy. J.G.  Kruthica  et al.   [12] \nidentified in their study that mutations in the MED12, \nHMGA2, COL4A5, FN1, TGFB3, and KLF6 genes were as -\nsociated with the formation of leiomyomas. Among these, \nmutations in the MED12 gene were found to be the most \ncommon cause of leiomyomas across different populations.\n35 33.33\nDisease30\n25\n20 16.67\n13.33 13.33 13.3315 10\n10\n5\n0\nCysts Thyroid Salpingoophoritis Endometrial\nhyperplasia\nAdenomyosis Dysfunctional\npathology uterine bleeding\n%\nFigure 2. Prevalence of gynecological pathologies in the history of examined women\nSource: created by the authors\nThe results of the histological examination of the re -\nmoved endometrium are presented in Figure 3. The most \nfrequent morphological form identified was simple atyp -\nical endometrial hyperplasia, which was diagnosed in 19 \nwomen. In six cases, an endometrial sample could not be \nobtained, most likely due to the prolonged nature of the \nbleeding, which resulted in either the absence or signifi -\ncant thinning of the uterine mucosa, rendering morpho -\nlogical analysis unfeasible.\nFigure 3. Structure of the results  \nof histological examination of the endometrium\nSource: created by the authors\n4.17\n79.17\n8.33\n8.33 Glandular-fibrous hyperplasia\nSimple, atypical hyperplasia\nMicropolyposis\nMixed hyperplasia\nHalf of the examined women (15 individuals) had a \nhistory of childbirth, while every fourth participant (8 \nwomen or 26.67%) reported having undergone a medical \ntermination of pregnancy. Spontaneous abortions were \nnoted in 5 women (16.67%). The average number of preg -\nnancies was 1.58  ± 0.14, deliveries – 1.24 ± 0.22, and abor-\ntions – 1.29 ± 0.09. It is notable that the maximum number \nof deliveries did not exceed two, induced abortions – three, \nand spontaneous abortions – one. Within the structure of \nsomatic pathology, arterial hypertension was the most fre-\nquently observed condition, recorded in 4 women (13.33%). \nIsolated cases of diabetes mellitus, liver disease, and renal \ndisorders were also noted. A history of thyroid pathology \nwas found in 12 women (40%), of whom half (6 patients, or \n20% of the total cohort) had hypothyroidism. Thyroid nod-\nules were identified in 5 women (16.67%), one woman had \nthyrotoxicosis, and another had undergone bilateral thy -\nroid lobe resection. The average duration of thyroid disease \nwas 7.46 ± 1.03 years.\nUltrasound examination of the thyroid gland revealed \nno abnormalities in only one patient. Nodular formations \nwere visualised in 15 women (50%), diffuse parenchymal \nchanges in 8 women (26.67%), follicular formations in 2 \ncases, and isolated cases of hyperplasia, thyroiditis, atro -\nphy, or post-resection changes were also observed. The \naverage volume of the thyroid gland was 10.78  ± 1.05 cm3, \nwith the right lobe measuring 6.57   ±  0.24  cm3 and the \nleft lobe 6.31  ± 0.17 cm3. The average volume of the nod -\nules was 0.86   ±  0.04  cm3. Ultrasound measurements of \nthe uterus and ovaries were consistent with age-relat -\ned norms. However, the M-echo thickness on days 5-7 of \nthe menstrual cycle was 10.06  ± 1.17  mm (range: 3.2  mm \nto 18.5 mm), exceeding physiological parameters and sug -\ngesting the presence of endometrial hyperplasia. Thyroid \nfunction assessment revealed the following hormone lev -\nels: thyroid-stimulating hormone (TSH) – 3.55 mIU/L, free \nthyroxine (T4)  – 16.03  pmol/L, triiodothyronine (T3)  – \n3.94 pmol/L, antibodies to thyroid peroxidase – 97.28 IU/\nmL, and thyroglobulin – 21.72 ng/mL. These findings indi-\ncate that the TSH level approached the upper limit of the \nnormal range, T3 was below normal, while other indicators \nremained within reference values.\nDuring the study, it was found that 60% of patients \nwith endometrial pathology had thyroid dysfunction. Sub-\nclinical hypothyroidism was most frequently diagnosed, \naccounting for 20% of cases, while clinical hypothyroidism \nand thyrotoxicosis were each observed in 10% of cases. \nAdditionally, a euthyroid state with elevated antibodies to \nthyroid peroxidase was recorded in 20% of patients, indi -\ncating autoimmune thyroid pathology without overt clin -\nical manifestations. A. Muzafar Jafaar & M.Q. Meena [13] \nreported that most cases of hypothyroidism in their study \nwere attributable to autoimmune thyroid disease, support-\ned by the presence of goitre and elevated levels of both an-\nti-thyroid antibodies.\n\nI. Ganzhiy and I. Sokolovska\n5353\nBulletin of Medical and Biological Research. 2025. Vol.7, No. 2\nendometrial hyperplasia in that study had hypothyroidism. \nThese data underscore the importance of assessing thyroid \nfunction in women with menstrual irregularities to ensure \ntimely diagnosis and effective treatment. A similar view -\npoint is presented by R.A. Safonov et al. [16], who reported \nthat significant abnormalities in steroid hormone levels in \nwomen with thyroid dysfunction support the existence of \na relationship between endometrial proliferative processes \nand thyroid function. Their findings, like the current study, \ndemonstrated a close association between thyroid dys -\nfunction and abnormal uterine bleeding.\nAs part of this research, patients were stratified into \nage groups to assess the influence of age on the frequency \nof thyroid dysfunction in the context of endometrial pa -\nthology. The highest frequency of thyroid dysfunction was \nrecorded in women aged 36-45 years, at 66.7% (10 out of \n15). In the younger cohort (20-35 years; 9 patients), the \nrate was 55.6% (5 women), and among those over 45 years \n(6 patients), it was 50% (3 women). These results indicate \na heightened vulnerability to endocrine dysregulation \namong women of mid-reproductive age, likely due to the \ncombined influence of hormonal fluctuations, stress, and \nmetabolic changes. F.  Memon  et al.   [17] also noted that \nthyroid fibrosis was most prevalent (36%) in middle-aged \npatients, while the thickness of the basement membrane \nwas lowest in younger patients (12%) and highest in older \npatients (31%), which supports the reliability of the pres -\nent data. The relationship between body mass index (BMI) \nand thyroid function was also examined. Among the 19 \noverweight patients (BMI >25), thyroid dysfunction was \nobserved in 73.7% (14 women). In contrast, among the 11 \npatients with normal weight (BMI ≤25), only 36.4% (4 wom-\nen) had thyroid dysfunction. Furthermore, of the 12 women \nwith confirmed hypothyroidism, 83.3% (10 patients) had a \nBMI over 25. This finding points to a close association be -\ntween reduced thyroid function and metabolic disturbanc-\nes, including obesity. E.M. Milewska-Kobos  et al. [18] and \nF. Torre et al. [19] have similarly indicated a connection be-\ntween increased body weight and thyroid status. Excessive \nobesity and adipose tissue dysfunction may contribute to \nthe development of thyroid disorders such as autoimmun -\nity, thyroid nodules, and thyroid cancer. The prevalence of \nthyroid disease is significantly higher among obese indi -\nviduals than in those with normal weight, particularly in \nthe presence of unhealthy obesity phenotypes.\nAmong the eight women diagnosed with autoimmune \nthyroiditis, three (37.5%) also exhibited ultrasound signs \nof polycystic ovary syndrome (PCOS). These patients ex -\nperienced prolonged anovulatory cycles and menstrual \nirregularities, which were associated with hyperplastic \nprocesses in the endometrium. It was found that five out \nof eight (62.5%) patients with autoimmune thyroiditis and \nchronic anovulation had complex forms of endometrial \nhyperplasia, including cases with proliferative and atypical \nchanges. This underscores the importance of thyroid func-\ntion in regulating the endocrine axis – hypothalamus-pi -\ntuitary-ovarian – and its influence on the endometrium. \nA retrospective analysis of reproductive history revealed \nthat out of 30 patients, nine women (30%) had a history of \nmiscarriage or infertility. Among these, seven (77.8%) had \nthyroid dysfunction, suggesting a potential role in the on -\nset or persistence of reproductive disorders. Specifically, \nAnalysis of the types of endometrial pathology re -\nvealed that the highest proportion of patients with thyroid \ndysfunction had endometrial hyperplasia  – comprising \n40% of the cohort. Among these, 70% had coexisting thy -\nroid dysfunction. In the subgroup with endometrial polyps, \nthyroid dysfunction was identified in 50% of cases. In pa -\ntients with atypical hyperplasia, observed in three indi -\nviduals, the incidence of thyroid pathology reached 30%, \nsuggesting a potential impact of thyroid hormone imbal -\nance on the development of more severe forms of endome-\ntrial hyperplasia. The relationship between thyroid-stim -\nulating hormone (TSH) levels and endometrial thickness \nwas also examined. In patients with elevated TSH levels \n(above 4 mIU/L), the average endometrial thickness was \n12.3 ± 2.1 mm, compared to 9.6 ± 1.7 mm in those with nor-\nmal TSH levels (p  < 0.01). This finding suggests a possible \nrole of hypothyroidism in promoting proliferative changes \nin the endometrium. B. Gautam et al. [14] analysed patients \nwho tested positive for anti-TPO antibodies, including 59 \nwomen. A significant positive correlation was observed be-\ntween TSH and anti-TPO levels, along with a negative cor-\nrelation between free T3, T4 and anti-TPO. These findings \nunderscore the value of anti-TPO level determination for \nthe early detection and confirmation of autoimmune thy -\nroid disease.Elevated levels of antibodies to thyroid perox-\nidase were found in 30% of the total cohort. Among these, \n60% also exhibited menstrual irregularities, such as ano -\nvulatory bleeding or secondary amenorrhoea. This further \nsupports the association between autoimmune thyroiditis \nand disrupted endometrial function.\nUltrasound examination of the thyroid gland revealed \nstructural changes in 40% of the participants. The most \ncommon findings included signs of diffuse thyroiditis and \nthe presence of nodules (20%). Nodular goitre was more \nfrequently observed in patients with endometrial polyps, \nwhereas diffuse changes predominated in the group with \nendometrial hyperplasia. Additionally, among women with \nelevated thyroid-stimulating hormone (TSH) levels and re-\nduced concentrations of free T4, 80% reported symptoms \nsuch as excess weight, increased fatigue, and dry skin, indi-\ncating the systemic nature of hypothyroidism. In this sub -\ngroup, delayed menstruation (60%) and anovulation were \nalso more common, suggesting that these endocrine dis -\nturbances may have contributed to the structural chang -\nes in the endometrium. Particular attention was given to \npatients with recurrent endometrial hyperplasia following \nhormonal therapy. In 60% of these cases, previously undi -\nagnosed or latent hypothyroidism was identified. This find-\ning suggests that untreated thyroid dysfunction may reduce \nthe effectiveness of treatment for endometrial pathologies. \nComparison of treatment outcomes showed that patients \nwhose thyroid function was normalised (via levothyroxine \nor antithyroid therapy) demonstrated better clinical out -\ncomes, including reduced endometrial thickness, regular -\nisation of the menstrual cycle, and a lower recurrence rate \nof hyperplasia. A. Nayak [15] conducted a study investigat-\ning the relationship between thyroid dysfunction and ab -\nnormal menstrual bleeding, reporting that 32.6% of partic-\nipants had hypothyroidism and 2.5% had hyperthyroidism. \nHypothyroidism was most common among women with \nmenorrhagia and metrorrhagia, as well as in cases of pu -\nbertal menorrhagia. Furthermore, 17.6% of patients with \n\nThyroid status in patients with endometrial pathology\n5454\nBulletin of Medical and Biological Research. 2025. Vol.7, No.2\nthree cases involved hypothyroidism, while two patients \nexhibited elevated titres of antibodies to thyroid peroxi -\ndase despite maintaining a euthyroid state. Such immune \nactivity could interfere with implantation or early embry -\nonic development. A.  Beadini  et al.   [20] also identified a \nlink between autoimmune thyroiditis and PCOS, report -\ning that among women with PCOS, 26.03% had markers \nof autoimmune thyroiditis (elevated anti-TPO or anti-Tg \nlevels), compared to only 9.72% in the control group. This \nsuggests a significantly higher risk of developing auto -\nimmune thyroiditis in women with PCOS, irrespective \nof geographic location or diagnostic criteria. Addition -\nal analysis of clinical symptoms associated with thyroid \ndysfunction demonstrated a relationship with the type of \nendometrial changes. Among the 12 patients with hypo -\nthyroidism, the most commonly reported symptoms were \nfatigue (83.3%, 10 women), facial or limb swelling (58.3%, \n7 women), dry skin (66.7%, 8 women), and menstrual ir -\nregularities (91.7%, 11 women). In contrast, among the \n12 patients without thyroid pathology, these symptoms \nwere significantly less frequent: fatigue (33.3%), swell -\ning (16.7%), dry skin (25%), and menstrual irregularities \n(41.7%). Statistical analysis confirmed a significant dif -\nference in the prevalence of these symptoms between the \ntwo groups (p   <  0.05), highlighting the clinical relevance \nof thyroid dysfunction in the development of endome -\ntrial disorders. Evaluation of the relationship between \nthyroid-stimulating hormone (TSH) levels and the type \nof endometrial pathology revealed that the highest mean \nTSH values were observed in patients with atypical hyper -\nplasia (5.1 ± 1.3 mIU/L). In those with simple hyperplasia, \nthe average TSH level was 4.2  ± 1.1 mIU/L, while patients \nwith polyps had a mean TSH of 3.4 ± 1.2 mIU/L. By compar-\nison, women without thyroid pathology had a significantly \nlower mean TSH level of 2.1   ±  0.7  mIU/L. These findings \nsuggest a potential progression of endometrial patholo -\ngy with increasing thyroid dysfunction. S.S.  Bahreiny  et \nal.  [21] similarly reported that in women with abnormal \nuterine bleeding, the most common histopathological \nfindings included proliferative endometrium, hyperplasia \nwithout atypia, and secretory endometrium. Hyperplastic \nendometrial changes were more prevalent in patients with \nhypothyroidism, further supporting the role of thyroid \ndysfunction in endometrial pathology. Additionally, endo-\nmetrial thickness as measured by ultrasound was found to \ncorrelate with histopathological findings: patients diag -\nnosed with endometrial hyperplasia had greater endome -\ntrial thickness than those in other groups.\nThe study analysed the effect of thyroid gland treat -\nment on the endometrium. Among six patients who re -\nceived levothyroxine replacement therapy for hypothy -\nroidism for at least six months, four (66.7%) demonstrated \npositive dynamics  – namely, a decrease in endometrial \nthickness (by an average of 2.4 mm), normalisation of the \nmenstrual cycle, and the disappearance or reduction of \nmenorrhagia. These findings indicate the effectiveness of \ncorrecting thyroid insufficiency as a key component in the \nmanagement of concomitant gynaecological pathology. \nAnother important aspect was the assessment of free T4 \nlevels in relation to endometrial pathology. Patients with \natypical hyperplasia had statistically lower free T4 levels \nthan those in other groups – 9.7  ± 1.4 pmol/L compared to \n12.2 ± 1.5 pmol/L in women with endometrial polyps. This \ncorrelation may reflect the duration and severity of hy -\npothyroidism as a contributing factor in the progression \nof endometrial pathology. The level of prolactin was also \nmeasured separately in patients with menstrual disorders \nand concurrent hypothyroidism. In six out of twelve such \nwomen (50%), a moderate increase in prolactin levels was \ndetected (mean value – 33.4  ± 4.5 ng/mL). This was likely \ndue to the stimulatory effect of elevated thyroid-stimulat-\ning hormone on prolactin production, which could nega -\ntively impact ovulatory function and contribute to chronic \nanovulation. The overall analysis of the study findings en-\nabled the identification of the most significant risk factors \nfor the development of thyroid dysfunction in women with \nendometrial pathology. More detailed information is pre -\nsented in Table 1.\nRisk factor Frequency  \nof occurrence Note\nOverweight (BMI>25 kg/m2) 63.6% Mostly associated with hypothyroidism\nAge 36-45 years 66.7% The highest incidence of thyroid dysfunction\nAtypical or recurrent endometrial hyperplasia 75% Accompanied by thyroid dysfunction\nAutoimmune thyroiditis 80% Often accompanied by menstrual irregularities\nReproductive losses (miscarriage, infertility, \npremature birth, fetal growth retardation) 77.8% In most cases – hypothyroidism or antibodies to \nthyroid peroxidase\nTable 1. Risk factors for thyroid pathology\nSource: created by the authors\nIn order to further analyse the relationship between \nthe functional state of the thyroid gland and the mor -\nphological structure of the endometrium, the results of \nhistological examination were assessed. In patients with \nhypothyroidism, proliferative changes predominated: sim-\nple or complex hyperplasia without atypia was identified \nin 66.7% (8 out of 12) of cases, and atypical hyperplasia \nin 25% (3 women). In only one case (8.3%) was secreto -\nry endometrium observed without pathological chang -\nes. In the group of women with normal thyroid function, \npathological changes were less pronounced: endometrial  \nhyperplasia was detected in 33.3% of cases (4 out of 12), and \nno atypical changes were observed. Furthermore, based on \nthe evaluation of the morphofunctional state of the endo -\nmetrium in patients with varying levels of thyroid-stimu -\nlating hormone (TSH), it was noted that the higher the TSH \nlevel, the greater the likelihood of persistent endometrial \nthickening, regardless of the phase of the menstrual cycle. \nIn 70% of patients with TSH >4.5  mIU/L, an endometrial \nthickness exceeding 11 mm was recorded, which is consid-\nered a pathological indicator for women of reproductive \nage, particularly in the luteal phase. In contrast, among  \n\nI. Ganzhiy and I. Sokolovska\n5555\nBulletin of Medical and Biological Research. 2025. Vol.7, No. 2\npatients with TSH <2.5 mIU/L, such thickness was observed \nin only 16.7% of cases. These findings suggest that disrup-\ntion of thyroid homeostasis may lead to increased stimula-\ntion of endometrial growth, potentially due to altered lev -\nels of gonadotropins or the influence of thyroid hormones \non the oestrogen-progesterone balance. In this context, it \nis important to highlight that the study found a statisti -\ncally significant correlation between TSH levels and the \nfrequency of hyperplastic processes in the endometrium.\nAnother important clinical consideration was the in -\nvestigation of anaemic syndrome in patients with con -\ncurrent endometrial and thyroid pathology. In nine wom -\nen (30% of the sample), haemoglobin levels were below \n110 g/L; in all these cases, both heavy menstrual bleeding \nand concomitant hypothyroidism or thyroiditis were pres -\nent. This supports the hypothesis of an indirect effect of hy-\npothyroidism on the intensity of uterine bleeding, possibly \nvia destabilisation of the endometrial layer. An additional \nexamination of inflammatory markers, particularly C-reac-\ntive protein (CRP), revealed that among patients with auto-\nimmune thyroid changes (elevated anti-thyroid peroxidase \nantibodies), CRP levels were raised in 54.5% of cases (6 out \nof 11), indicating possible systemic immune activation. This \nfinding suggests a potential role for immune mechanisms \nin the pathogenesis of endometrial changes, especially in \nthe context of autoimmune thyroiditis as a systemic con -\ndition. Analysis of lifestyle and associated factors demon -\nstrated that 10 patients (33.3%) experienced chronic stress \nor psycho-emotional exhaustion. Within this subgroup, \nthyroid pathology was identified in 70% of cases (7 women).\nIt was also recorded that six patients (20%) were tak -\ning combined oral contraceptives at the time of examina -\ntion. Among them, only one woman was diagnosed with \nhypothyroidism, while the remainder had thyroid function \nwithin normal limits. This provided grounds to assume that \nhormonal contraception may stabilise the hormonal back -\nground to some extent, but does not influence autoimmune \nprocesses. It should also be noted that comorbid pathology \nwas identified in five patients: arterial hypertension (three \ncases) and insulin resistance (two cases). All these women \nhad concomitant hypothyroidism, suggesting the presence \nof a general metabolic syndrome in which thyroid insuffi -\nciency plays a significant role. Thus, the results obtained \ndemonstrate the multifactorial influence of the thyroid \ngland on the condition of the endometrium. Dysfunction of \nthis organ is associated not only with morphological chang-\nes in the endometrium, but also with general somatic and \nmetabolic disorders, significantly complicating the clinical \npicture. This once again highlights the need for an individ-\nualised approach to the examination and treatment of such \npatients, with mandatory consideration of thyroid status \nin each case. H.D. Sahu et al. [22] analysed the relationship \nbetween hormonal oral contraceptives and thyroid func -\ntion. Oral contraceptives containing oestrogens increase \nthe level of thyroxine-binding globulin, which leads to a \nrise in the total serum levels of T4 and T3, while the levels \nof free hormones remain stable. This may complicate the \ninterpretation of thyroid function test results, especially \nin women receiving levothyroxine replacement therapy, \nas an increase in thyroxine-binding globulin may reduce \nthe bioavailability of free T4, necessitating an adjustment \nin the levothyroxine dose. In addition, in women with  \nsubclinical hypothyroidism or those on levothyroxine ther-\napy, oral contraceptives may increase the risk of thrombo-\nembolic and cardiovascular complications. Therefore, when \nprescribing oral contraceptives to women with thyroid dys-\nfunction, it is essential to consider potential changes in the \nhormonal profile and adjust therapy accordingly.\nThe investigation into the relationship between the \nlevel of antibodies to thyroid peroxidase and the type of \nendometrial pathology deserves particular attention. An -\ntibodies to thyroid peroxidase were detected in 11 patients \n(36.7%), of whom nine had morphologically confirmed en-\ndometrial hyperplasia (81.8%). In five cases (45.5%), the \nhyperplasia was atypical, indicating the potential role of \nautoimmune inflammation in the development of prolif -\nerative processes in the endometrium. Notably, atypical \nhyperplasia was not observed in women without elevated \nlevels of antibodies to thyroid peroxidase. This pattern \nsuggests that autoimmune processes in the thyroid gland \nmay exert systemic effects and contribute to destructive \nchanges in the endometrium. The study also assessed the \ninfluence of reproductive history on the likelihood of de -\nveloping thyroid dysfunction. Among infertile patients \n(six women), hypothyroidism of varying degrees or elevat-\ned antibodies to thyroid peroxidase were identified in five \ncases (83.3%). All these women also exhibited hyperplastic \nchanges in the endometrium, further supporting the hy -\npothesis that thyroid dysfunction is involved in impaired \nimplantation processes and the development of chronic \nanovulation. By contrast, among patients with at least one \nprevious normal pregnancy, thyroid pathology was detect-\ned in only 33.3% of cases (six out of 18 women). A. Muzafar \nJafaar & M.Q. Meena [13] demonstrated in their study that \nmost cases of hypothyroidism are associated with autoim -\nmune processes, as evidenced by the high frequency of An-\nti-TPO and Anti-Tg antibodies and the presence of goitre \nin patients. These findings underscore the importance of \naccounting for the autoimmune component in the diagno-\nsis and treatment of hypothyroidism. Similarly, a study by \nI. Upadhyay et al. [23] found that most patients with thyroid \ndisease tested positive for thyroid peroxidase antibodies, \nconfirming the autoimmune nature of these conditions. \nThe detection of diffuse hypoechogenicity on ultrasound \nclosely correlated with the presence of Anti-TPO antibod -\nies, highlighting the value of ultrasound diagnostics as a \nnon-invasive, safe, and cost-effective method for the de -\ntection and prognosis of autoimmune thyroid diseases.\nThe influence of seasonal factors was also examined. \nAmong the 30 patients assessed, 18 were evaluated during \nthe autumn-winter period. Of these, 11 women (61.1%) \nexhibited signs of thyroid dysfunction, compared to 6 of \n12 patients (50%) examined in the spring-summer period. \nAlthough the difference was not statistically significant, \nit may suggest seasonal fluctuations in thyroid function, \nparticularly in regions characterised by low insolation or \niodine deficiency. In several cases (three patients), hypo -\nthyroidism was found in combination with other autoim -\nmune conditions  – specifically, one case of rheumatoid \narthritis and two cases of subclinical gastritis with pos -\nitive antibodies to parietal cells. These findings support \nthe systemic nature of the autoimmune process, which \nextends beyond the thyroid gland and may potentially re -\nsult in multiorgan involvement, including disruption of  \n\nThyroid status in patients with endometrial pathology\n5656\nBulletin of Medical and Biological Research. 2025. Vol.7, No.2\nendometrial structure. Overall, the detection rate of sub -\nclinical hypothyroidism was slightly higher (13.3%) than \nthat of clinical hypothyroidism (10%), reinforcing the \nimportance of screening for thyroid function even in the \nabsence of overt symptoms. Most patients with subclini -\ncal hypothyroidism had elevated thyroid-stimulating hor -\nmone (TSH) levels with normal free T4 levels; however, \neven at this stage, they already presented with menstru -\nal irregularities, increased endometrial thickness, and a \nheightened risk of hyperplastic processes. A comprehen -\nsive evaluation of the effectiveness of an interdisciplinary \napproach to managing patients with endometrial pathol -\nogy and concurrent thyroid dysfunction was undertaken. \nIt was found that, when an endocrinologist participat -\ned in correcting thyroid status, positive outcomes were \nachieved in 10 out of 13 such cases (76.9%), both in terms \nof reproductive function (normalisation of the menstrual \ncycle, onset of ovulation) and in the morphological con -\ndition of the endometrium (reduction in hyperplasia, re -\ngression of polyps). A.S. Vishen et al. [24] also determined \nthat seasonal changes affect the histochemical properties \nof the thyroid gland. Specifically, during winter, the gland \ndemonstrates increased functional activity, possibly as \nan adaptive response to decreased ambient temperature. \nI. Domuschiev [25], in studying the impact of global warm-\ning on the thyroid gland, found that elevated ambient tem-\nperatures may lead to hormonal imbalance, increasing the \nrisk of thyroid disease. Climate change may also affect the \navailability of iodine in food, which is crucial for thyroid \nhormone synthesis.\nAnother significant area of investigation was the im -\npact of body weight and body mass index (BMI) on the \nfunctional state of the thyroid gland and the nature of \nendometrial pathology. Among the 30 patients, 16 wom -\nen (53.3%) were overweight or obese (BMI >25 kg/m 2), of \nwhom 11 (68.8%) exhibited signs of thyroid dysfunction, \nprimarily subclinical or overt hypothyroidism. Conversely, \namong women with normal body weight (14 individuals), \nthyroid dysfunction was detected in only 4 cases (28.6%). \nThis disparity indicates a strong association between met-\nabolic disorders and thyroid function. Overweight patients \nalso more frequently exhibited hyperplastic changes in \nthe endometrium – 75% of cases (12 out of 16) – includ -\ning both simple and atypical hyperplasia. This underscores \nthat excess body weight may act not only as an independ -\nent risk factor for endometrial hyperplasia but also as an \namplifying factor in the adverse effects of thyroid dysfunc-\ntion on hormonal homeostasis. An analysis of the study by \nS.B. Kaur et al. [26] confirmed that the group with elevated \nBMI had a greater mean endometrial thickness and a high-\ner incidence of atypical endometrial hyperplasia. Notably, \nthe frequency of atypical endometrial hyperplasia was sig-\nnificantly higher among women with increased BMI.\nIt is important to note that among all the examined \nwomen, 10 cases (33.3%) exhibited anovulatory or irregu -\nlar menstrual cycles, and thyroid pathology was detected \nin 8 of these cases. In three women, the menstrual cycle \nexceeded 45 days, indicating a marked disruption of ovu -\nlation. Following correction of thyroid-stimulating hor -\nmone (TSH) levels and normalisation of T4 and T3 con -\ncentrations over a period of 3-6 months, normalisation of \nthe menstrual cycle was achieved. In two cases, pregnancy \noccurred within one year following comprehensive treat -\nment, further supporting the role of thyroid dysfunction in \nfertility disorders. H.I. Aliu-Ayo  et al. [27] similarly found \nthat menstrual disorders, such as oligomenorrhoea and \namenorrhoea, were more prevalent among infertile women \nwith thyroid dysfunction. A significant correlation was also \nobserved between thyroid hormone levels and different \ntypes of menstrual cycles.\nTo assess the emotional state of the patients, a sur -\nvey was conducted. In 12 women (40%), mild or moderate \ndepressive syndrome was recorded, of whom nine exhibit -\ned signs of hypothyroidism. This finding corroborates the \nwell-documented clinical association between thyroid in -\nsufficiency and depressive states. It also highlights the ne-\ncessity of considering the psycho-emotional component in \nthe management of such patients, particularly when plan -\nning hormone therapy. Among the 30 patients, only three \nwomen (10%) presented a normal histological picture of \nthe endometrium despite clinical evidence of thyroid dys -\nfunction. In these instances, it may be assumed that thy -\nroid pathology had not yet progressed sufficiently to induce \nmorphological changes, or that compensatory mechanisms \nhad temporarily offset its effects. I.I. Rodrigues da Cunha et \nal. [28] demonstrated that even minor alterations in thy -\nroid hormone levels can influence brain function and con-\ntribute to the development of depression. Specifically, thy-\nroid dysfunction may result in reduced levels of serotonin \nand noradrenaline in the central nervous system, both of \nwhich are characteristic of depressive states. This finding \nfurther underscores the importance of early diagnosis and \nintervention, even in the presence of minimal symptoms. \nSimilar conclusions were drawn in the studies by K. Gökçe \n& D. Doğan [29] and J. Fedorko et al. [30].\nThe results of ultrasound examination of the thyroid \ngland were also included in the analysis. Diffuse changes \ncharacteristic of thyroiditis was identified in 14 women \n(46.7%), including hypoechogenicity, structural heteroge -\nneity, and increased vascularisation. Of these, 11 women \nhad positive titres of antibodies to thyroid peroxidase, con-\nfirming the autoimmune nature of the thyroid pathology. \nThyroid nodules were detected in five patients (16.7%), \nalthough only two of these were associated with hormo -\nnal activity. No cases of malignant lesions were identified. \nWhile this suggests a relatively low oncological risk within \nthe sample, it highlights the importance of regular ultra -\nsound monitoring in women presenting with both hyper -\nplastic changes in the endometrium and nodular altera -\ntions in the thyroid gland. In summary, the study results \nconfirmed not only the statistical, but also the clinical \nsignificance of thyroid dysfunction in patients with endo -\nmetrial pathology. Particular attention should be given to \nwomen with hypothyroidism, positive autoimmune mark -\ners, excess body weight, and irregular menstrual cycles. \nThese factors significantly increase the risk of developing \nproliferative changes in the endometrium and, in some \ninstances, may contribute to the development of atypical \nforms of hyperplasia.\nThe ultrasound findings, when considered alongside \nlaboratory indicators, enabled a more comprehensive char-\nacterisation of the structural and functional state of the \nthyroid gland in women with endometrial pathology. The \nobserved diffuse changes, nodular formations, and signs of \n\nI. Ganzhiy and I. Sokolovska\n5757\nBulletin of Medical and Biological Research. 2025. Vol.7, No. 2\nautoimmune processes confirm the close interrelationship \nbetween the endocrine and reproductive systems. This di -\nagnostic approach facilitates not only the timely identifi -\ncation of co-existing pathologies but also the development \nof individualised monitoring and treatment plans. Such an \napproach is particularly crucial for the prevention of hyper-\nplastic and atypical changes in the endometrium. Thus, the \nfindings of the study provide a foundation for the formu -\nlation of practical recommendations and evidence-based \nconclusions.\ne CONCLUSIONS\nThe study revealed a significant association between thy -\nroid pathology and endometrial changes in patients with \nvarious forms of endometrial disease. Among the 30 pa -\ntients included in the study, 60% were found to have thy -\nroid dysfunction. Specifically, overt hypothyroidism was \npresent in 10% of cases, subclinical hypothyroidism in \n13.3%, and elevated levels of antibodies to thyroid per -\noxidase – indicative of autoimmune thyroid disease – in \n36.7%. Simultaneously, 73.3% of patients were diagnosed \nwith endometrial hyperplasia. Among these, 36.4% had \nsimple hyperplasia without atypia, 18.2% had complex hy-\nperplasia, and 45.5% had atypical hyperplasia, reflecting a \nsubstantial proportion of patients at increased oncological \nrisk. This distribution of morphological types of hyperpla -\nsia is clinically significant for patient assessment and fur -\nther management, particularly in the context of concomi -\ntant endocrine disorders.\nSpecial attention should be directed toward over -\nweight patients, as thyroid dysfunction was observed in \n68.8% of such cases, and endometrial hyperplasia in 75%. \nAn even higher prevalence of thyroid disorders – 80% – was \nnoted in patients with anovulatory cycles. The correction \nof thyroid status was shown to have a beneficial effect on \nmenstrual cycle regulation and the restoration of ovula -\ntion in some patients. In several instances, treatment led \nto normalisation of endometrial thickness and improved \nreproductive function, underscoring the importance of \nearly diagnosis and intervention in thyroid pathology. The \nfindings support the necessity of routine screening for thy-\nroid function in patients with endometrial pathology. Early \nidentification of dysfunction allows for timely intervention \nto prevent the progression of hyperplastic endometrial \nchanges. Including ultrasound examination of the thyroid \ngland in the standard diagnostic protocol for women with \nendometrial disorders is both appropriate and advisable in \nclinical practice.\nThus, the results of this study underscore the impor -\ntance of comprehensive diagnostic and therapeutic ap -\nproaches in managing patients with endometrial pathol -\nogy. This includes not only the treatment of endometrial \nabnormalities but also the correction of thyroid dysfunc -\ntion, which significantly improves clinical outcomes and \nreproductive potential. A key strength of this study lies in \nthe integrated analysis of morphological variants of endo -\nmetrial hyperplasia alongside types of thyroid dysfunction, \nenabling a deeper exploration of the pathogenetic links \nbetween endocrine and gynaecological disorders. This con-\ntrasts with most previous studies, which have tended to \nexamine these conditions in isolation. One of the prima -\nry limitations of the present study is the relatively small \nsample size, which affects the statistical power and limits \nthe generalisability of the findings. Future research should \naim to expand the study population, adopt a multicentre \napproach, and incorporate long-term dynamic observation \nwith consideration of therapeutic interventions.\ne ACKNOWLEDGEMENTS\nNone.\ne FUNDING\nNone.\ne CONFLICT OF INTEREST\nNone.\ne REFERENCES\n[1] Strakhovetska YuV. The women of postmenopausal age have features of hyperplastic processes of endometrium. \nPerinatol Reproductol Res Pract. 2024;4(3-1):91–8. DOI: 10.52705/2788-6190-2024-03.1-13\n[2] Al-Kaabi M, Noel K, Al-Rubai AJ. Evaluation of immunohistochemical expression of stem cell markers (NANOG and \nCD133) in normal, hyperplastic, and malignant endometrium. J Med Life. 2022;15(1):117–23. DOI: 10.25122/jml-\n2021-0206\n[3] Leshchova OD. Hyperplastic processes of endometrium: Clinic of different forms early in life. Perinatol Reproductol \nRes Pract. 2024;4(1):51–6. DOI: 10.52705/2788-6190-2024-01-08\n[4] Orishchak IK, Kusa OM, Henyk NI, Makarchuk OM, Hodlevska NA. Assessment of the microbiota state of the \nreproductive tract in patients with hyperplastic processes of the endometrium. Art Med. 2020;24(4):114–20. \nDOI: 10.21802/artm.2022.4.24.114\n[5] Kulyk II, Khmil SV. Endometriosis-associated infertility: The role of hormones and its correction. Int J Med Med Res. \n2020;6(2):5–10. DOI: 10.11603/ijmmr.2413-6077.2020.2.12011\n[6] Brenta G, Hostalek U. Comorbidities of hypothyroidism. Curr Med Res Opin. 2025;41(3):421–9. \nDOI: 10.1080/03007995.2025.2476075  \n[7] Jara LJ, Medina G, Cruz-Dominguez M, Saavedra MA. Atrophic autoimmune thyroiditis. In: Shoenfeld Y, Cervera R, \nEspinosa G, Gershwin ME, editors. Autoimmune disease diagnosis: Systemic and organ-specific diseases. Cham: \nSpringer; 2025. P . 345–50. DOI: 10.1007/978-3-031-69895-8_47\n[8] Beraya DYu. Features of gynecological pathology in women with infertility and pathology of the thyroid gland. \nReprod Health. 2022;63(8):68–72. DOI: 10.30841/2708-8731.8.2022.273298  \n[9] Huang J, Li Y, Chen P , Zhi Z. The risk factors and prognostic impact of different benign pathologic types of \nbackground endometrium surrounding endometrial polyps. Int J Gynecol Obstet. 2024;169(1):247–57. \nDOI: 10.1002/ijgo.16067\n\nThyroid status in patients with endometrial pathology\n5858\nBulletin of Medical and Biological Research. 2025. Vol.7, No.2\n[10] The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human \nSubjects [Internet]. [cited 2024 December 13]. Available from: https://www.wma.net/what-we-do/medical-ethics/\ndeclaration-of-helsinki/\n[11] World Health Organization. Female Genital Tumours: WHO Classification of Tumours, 5th Edition, Volume 4 [Internet]. \n2020 [cited 2024 December 13]. Available from: https://publications.iarc.who.int/Book-And-Report-Series/Who-\nClassification-Of-Tumours/Female-Genital-Tumours-2020\n[12] Kruthica JG, Iyshwarya BK, Veerabathiran R. Review on genetic insights into abnormal uterine bleeding and \nleiomyoma development. Tanzania J Health Res. 2024;25(4):1324–45. DOI: 10.4314/thrb.v25i4.8\n[13] Muzafar Jafaar A, Meena МQ. Anti-thyroid peroxidase and anti-thyroglobulin antibodies in patients with \nhypothyroidism. J Med Sci Clin Res. 2024;4(8):12052–60. DOI: 10.18535/jmscr/v4i8.62\n[14] Gautam B, Poudel S, Pokhrel S. Significance of thyroid peroxidase antibodies (anti-TPO antibodies) in patients \nundergoing thyroid function tests. J Gandaki Med Coll-Nepal. 2024;17(2):111–6. DOI: 10.3126/jgmc-n.v17i2.70774\n[15] Nayak A. Thyroid disorders in patients with dysfunctional uterine bleeding. Panacea J Med Sci. 2025;11(3):503–6. \nDOI: 10.18231/j.pjms.2021.098\n[16] Safonov RA, Alekseieva OS, Lazurenko VV. Treatment tactics for genital prolapses in women with abnormal uterine \nbleeding and thyroid gland pathology. Actual Probl Mod Med. 2023;23(1):69–72. DOI: 10.31718/2077-1096.23.1.69\n[17] Memon F, Ali S, Rawtani G, Rasul S, Shaikh F, Fatima A. Age related cytoarchitectural comparison of histopathological \nchanges in thyroid nodule. J Bahria Univ Med Dent Coll. 2023;13(2):135–9. DOI: 10.51985/JBUMDC2022107\n[18] Milewska-Kobos EM, Szczepanek-Parulska E, Ruchała M. Is there a link between obesity phenotype and thyroid \ndiseases? A mini-review of current concepts. Adv Hyg Exp Med. 2023;77(1):107–17. DOI: 10.2478/ahem-2023-0015\n[19] Torre F, Calogero AE, Condorelli RA, La Vignera S. Effects of oral contraceptives on thyroid function and vice versa. \nJ Endocrinol Invest. 2020;43:1181–8. DOI: 10.1007/s40618-020-01230-8\n[20] Beadini A, Ameti I, Elezi A, Ziberi E, Shabani A, Ademi S. Correlation between the disorder of the thyroid gland, \nobesity and overweight in the female gender. Acta Med Balk. 2024;9(17-18):47–56. DOI: 10.62792/ut.amb.v9.i17-18.\np2549\n[21] Bahreiny SS, Dabbagh MR, Harooni E, Ebrahimi R. Prevalence of autoimmune thyroiditis in women with polycystic \novary syndrome: A systematic review and meta-analysis. Iran J Obstet Gynecol Infertil. 2023;26(1):94–106. \nDOI: 10.22038/ijogi.2023.22163\n[22] Sahu HD, Varma A, Karmarkar S, Kesharwani P . Endometrial histopathology in abnormal uterine bleeding and its \nrelation with thyroid profile and endometrial thickness. Cureus. 2023;15(4):e37931. DOI: 10.7759/cureus.37931\n[23] Upadhyay I, Kukrele P , Rathore VS. Study and correlation of anti thyroid peroxidase antibody and ultrasonography \nfindings of thyroid in patients of thyroid diseases. Int J Adv Res. 2023;11(5):788–95. DOI: 10.21474/IJAR01/16933\n[24] Vishen AS, Gupta V, Singh SP , Verma A, Yadav R, Gupta RK, et al. The histochemical study of the thyroid gland of \nChabro chicken reared in summer and winter seasons. Ind J An Res. 2021;55(3);283–6. DOI: 10.18805/IJAR.B-3973\n[25] Domuschiev I. The effects of global climate warming on the thyroid glandandits diseases. 2024. DOI:  10.13140/\nRG.2.2.21102.22088\n[26] Kaur SB, Singh S, Singh A. Correlation of body mass index with endometrial pathology in perimenopausal women \nwith AUB: A prospective study. J Mid-Life Health. 2025;16(1):19–25. DOI: 10.4103/jmh.jmh_254_23\n[27] Aliu-Ayo HI, Adesina KT, Jimoh AA, Ikwuka AO, Udeh FC, Biliaminu SA, et al. Correlation of thyroid gland functions \nwith menstrual patterns amongst infertile and fertile women attending a tertiary care hospital in north-central \nNigeria. J Clin Med Res. 2023;3:787. DOI: 10.31586/wjcmr.2023.787\n[28] Rodrigues da Cunha II, Lopes AC, Silva A, Araújo FM, Mendes GA, Roehrs DD, et al. Relationship between thyroid function \nand Major Depressive Disorder (MDD): An integrative literature review. Res Soc Dev. 2022;11(12):e599111235270. \nDOI: 10.33448/rsd-v11i12.35270\n[29] Gökçe K, Doğan D. Surgical oncology-based check-up program and determining of asymptomatic pathologies. \nEskisehir Med J. 2025;6(1):36–44. DOI: 10.48176/esmj.2025.178\n[30] Fedorko J, Fatima S, Amblee AP , Poku CA. A case of high-risk thyroid tumor markers found in subcutaneous thyroid \nimplants in a patient with benign thyroid pathology. J Endocr Soc. 2024;8(1):bvae163.1841. DOI: 10.1210/jendso/\nbvae163.1841\n\nI. Ganzhiy and I. Sokolovska\n5959\nBulletin of Medical and Biological Research. 2025. Vol.7, No. 2\nСтан щитоподібної залози у пацієнтів з патологією ендометрію\nІрина Ганжий\nДоктор медичних наук, професор\nЗапорізький державний медико-фармацевтичний університет\n69035, бульв. Марії Примаченко, 26, м. Запоріжжя, Україна\nhttps://orcid.org/0009-0008-2490-5222\nІрина Соколовська\nКандидат медичних наук, асистент\nЗапорізький державний медико-фармацевтичний університет\n69035, бульв. Марії Примаченко, 26, м. Запоріжжя, Україна\nhttps://orcid.org/0009-0008-2487-1675\nАнотація. Метою цього дослідження було вивчення функціонального стану щитовидної залози у жінок із \nгіперпластичними процесами ендометрію, з огляду на зростаючий інтерес до ролі тиреоїдної дисфункції \nв етіопатогенезі проліферативних змін слизової оболонки матки. У дослідження було включено 30 жінок \nпізнього репродуктивного та перименопаузального віку, а саме 14-50 років, у яких діагностовано різні \nформи гіперпластичної патології ендометрію, на базі Запорізької медичної академії післядипломної освіти \nМіністерства охорони здоров'я України. Методологія дослідження передбачала клініко-лабораторне обстеження \nпацієнток, включаючи ультразвукову діагностику органів малого таза, гістологічне дослідження ендометрію, \nа також визначення рівнів тиреотропного гормону, вільних фракцій тироксину і трийодтироніну, антитіл до \nтиреоїдної пероксидази. Основні результати дослідження показали, що жінки із гіперплазією ендометрію мали \nсупутні порушення функції щитовидної залози, серед яких спостерігався субклінічний або явний гіпотиреоз. \nВиявлено зростання рівня тиреотропного гормону (3,8   ±  1,2  мМО/л) у пацієнток з гіперплазією ендометрію \nпорівняно з контрольною групою, а також збільшення концентрації антитіл до тиреоїдної пероксидази, що \nсвідчить про автоімунний характер порушень. Аналіз отриманих даних дозволив виявити взаємозв’язок \nміж вираженістю тиреоїдної дисфункції та морфологічним варіантом гіперпластичних змін ендометрію: у \nжінок з атиповою гіперплазією діагностували клінічно значимі порушення функції щитоподібної залози. \nОтримані результати свідчать про доцільність рутинного скринінгу тиреоїдної функції у жінок з гіперплазією \nендометрію для виявлення прихованих форм тиреоїдної патології, яка може бути як фоновим, так і тригерним \nчинником проліферативних змін ендометрію. Таким чином, результати дослідження підтверджують важливість \nінтегрованого підходу до діагностики та лікування гіперпластичних процесів ендометрію з урахуванням стану \nщитоподібної залози та ендокринної системи вцілому\nКлючові слова:  тиреотропні гормони; менопауза; тиреоїдна дисфункція; антитіла до тиреоїдної пероксидази; \nгіперплазія тканини; репродуктивний вік","source_license":"CC0","license_restricted":false}