Evaluation of the relationship between thyroid hormones and endometriosis: a clinical investigation

Endometriosis is a chronic gynecological condition that affects reproductive-aged women. This study evaluated the correlation between thyroid hormone levels and endometriosis severity.

A cross-sectional study was conducted at Shohada Tajrish Hospital and Atieh Hospital from September 2024 to April 2025. Participants diagnosed with endometriosis underwent clinical, ultrasound, and thyroid hormone assessments. Statistical analyses were used to explore correlations between hormone levels and endometriosis severity.

Significant associations were found between anti-TPO levels and UBESS stage 2. Pain severity was higher in moderate disease. However, TSH, T3, and Free T4 levels showed no significant correlations with disease stage or pain severity. Adhesion levels were associated with nodule presence and uterosacral ligament thickness.

Elevated anti-TPO levels may indicate autoimmune involvement in moderate endometriosis. Structural markers on ultrasound, such as nodule count and USL thickness, may predict disease severity. Metrics

Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Prim. 2018;4(1):9. DOI: https://doi.org/10.1038/s41572-018-0008-5 Tsamantioti E, Mahdy H. Endometriosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Nowak I, Bochen P. the antigen-processing pathway via major histocompatibility complex I as a new perspective in the diagnosis and treatment of endometriosis. Arch Immunol Ther Exp. 2024;72(1). DOI: https://doi.org/10.2478/aite-2024-0008 Szypłowska M, Tarkowski R, Kułak K. The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review. Front Public Health. 2023;11. DOI: https://doi.org/10.3389/fpubh.2023.1230303 Cano-Herrera G, Salmun Nehmad S, Ruiz de Chávez Gascón J, Méndez Vionet A, van Tienhoven XA, Osorio Martínez MF, et al. Endometriosis: a comprehensive analysis of the pathophysiology, treatment, and nutritional aspects, and its repercussions on the quality of life of patients. Biomedicines. 2024;12(7). DOI: https://doi.org/10.3390/biomedicines12071476 Adilbayeva A, Kunz J. Pathogenesis of endometriosis and endometriosis-associated cancers. Int J Mol Sci. 2024;25(14):7624. DOI: https://doi.org/10.3390/ijms25147624 Signorile PG, Viceconte R, Baldi A. New insights in pathogenesis of endometriosis. Front Med. 2022;9:879015. DOI: https://doi.org/10.3389/fmed.2022.879015 Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. Int J Mol Sci. 2023;24(5). DOI: https://doi.org/10.3390/ijms24054254 Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. DOI: https://doi.org/10.1038/s41574-019-0245-z Brown E, Obeng-Gyasi B, Hall J, Shekhar S. The thyroid hormone axis and female reproduction. Int J Mol Sci. 2023;24. DOI: https://doi.org/10.3390/ijms24129815 Silva J, Ocarino N, Serakides R. Thyroid hormones and female reproduction. Biol Reprod. 2018;99:907-21. DOI: https://doi.org/10.1093/biolre/ioy115 Ren B, Zhu Y. A new perspective on thyroid hormones: crosstalk with reproductive hormones in females. Int J Mol Sci. 2022;23. DOI: https://doi.org/10.3390/ijms23052708 Peyneau M, Kavian N, Chouzenoux S, Nicco C, Jeljeli M, Toullec L, et al. Role of thyroid dysimmunity and thyroid hormones in endometriosis. Proceed Nat Acad Sci. 2019;116:11894-9. Şerifoğlu H, Arınkan SA, Pasin O, Vural F. Is there an association between endometriosis and thyroid autoimmunity? Rev Assoc Méd Brasil. 2023;69. DOI: https://doi.org/10.1590/1806-9282.20221679 Zhang H, Sheng S, Pan Z, Zhao L, Yang C, Li C, et al. Immune and endocrine regulation in endometriosis: what we know. J Endomet Uter Disord. 2023;4:100049. DOI: https://doi.org/10.1016/j.jeud.2023.100049 May KE, Conduit-Hulbert SA, Villar J, Kirtley S, Kennedy SH, Becker CM. Peripheral biomarkers of endometriosis: a systematic review. Hum Reprod Update. 2010;16(6):651-74. DOI: https://doi.org/10.1093/humupd/dmq009 Espada M, Leonardi M, Aas-Eng K, Lu C, Reyftmann L, Tetstall E, et al. A Multicenter international temporal and external validation study of the ultrasound-based endometriosis staging system. J Minim Invasive Gynecol. 2021;28(1):57-62. DOI: https://doi.org/10.1016/j.jmig.2020.04.009 Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arth Care Res. 2011;63 Suppl 11:S240-52. DOI: https://doi.org/10.1002/acr.20543 Alinia-Ahandani E, Matwalli MMAS, Hosseinnejad S, Sheydaei M, Darzi-Ramandi H, Alizadeh-Tarpoei Z, et al. Assessment of the relation of anti-TPO and TSH, T3 and T4 levels between some subclinical diabetes patients in Iran. J Pharm Res Int. 2022;34(31A):16-25. DOI: https://doi.org/10.9734/jpri/2022/v34i31A36081 Meamar R, Feizi A, Aminorroaya A, Amini M, Nasri M, Tabatabaei A, et al. A thyroid stimulating hormone reference range: Iranian thyroid cohort study. Acta Biomed. 2021;92(5):e2021283. Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight J, et al. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019;25:486-503. DOI: https://doi.org/10.1093/humupd/dmz014 Porpora M, Scaramuzzino S, Sangiuliano C, Piacenti I, Bonanni V, Piccioni M, et al. High prevalence of autoimmune diseases in women with endometriosis: a case-control study. Gynecol Endocrinol. 2019;36:356-9. DOI: https://doi.org/10.1080/09513590.2019.1655727 Ashkenazi MS, Huseby OL, Kroken G, Trocha M, Henriksson A, Jasiak H, et al. The clinical presentation of endometriosis and its association to current surgical staging. J Clin Med. 2023;12. DOI: https://doi.org/10.3390/jcm12072688 Warzecha D, Szymusik I, Wielgoś M, Pietrzak B. The impact of endometriosis on the quality of life and the incidence of depression- a cohort study. Int J Environ Res Public Health. 2020;17. DOI: https://doi.org/10.3390/ijerph17103641 Fan P, Li T. Unveil the pain of endometriosis: from the perspective of the nervous system. Exp Rev Mol Med. 2022;24. DOI: https://doi.org/10.1017/erm.2022.26 Maddern J, Grundy L, Castro J, Brierley SM. Pain in endometriosis. Front Cell Neurosci. 2020;14:590823. DOI: https://doi.org/10.3389/fncel.2020.590823 Petta CA, Arruda MS, Zantut-Wittmann DE, Benetti-Pinto CL. Thyroid autoimmunity and thyroid dysfunction in women with endometriosis. Hum Reprod. 2007;22(10):2693-7. DOI: https://doi.org/10.1093/humrep/dem267 Korošec S, Riemma G, Šalamun V, Franko Rutar A, Laganà AS, Chiantera V, et al. Coexistence of endometriosis and thyroid autoimmunity in infertile women: impact on in vitro fertilization and reproductive outcomes. Gynecol Obstet Investig. 2024;89(5):413-23. DOI: https://doi.org/10.1159/000539265 Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, et al. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imag. 2018;9(2):149-72. DOI: https://doi.org/10.1007/s13244-017-0591-0 Somigliana E, Vigano P, Benaglia L, Busnelli A, Vercellini P, Fedele L. Adhesion prevention in endometriosis: a neglected critical challenge. J Minim Invas Gynecol. 2012;19(4):415-21. DOI: https://doi.org/10.1016/j.jmig.2012.03.004 Maple S, Bezak E, Chalmers KJ, Parange N. Relationship between ultrasound diagnosis, symptoms and pain scale score on examination in patients with uterosacral ligament endometriosis. J Clin Med. 2024;13(22). DOI: https://doi.org/10.3390/jcm13226901 Ferrero S, Vellone VG, Barra F. Pathophysiology of pain in patients with peritoneal endometriosis. Ann Transl Med. 2019;7(Suppl 1):S8. DOI: https://doi.org/10.21037/atm.2019.01.36 Peyneau M, Kavian N, Chouzenoux S, Nicco C, Jeljeli M, Toullec L, et al. Role of thyroid dysimmunity and thyroid hormones in endometriosis. Proc Nat Acad Sci USA. 2019;116(24):11894-9. DOI: https://doi.org/10.1073/pnas.1820469116 Hudelist G. Re: sonographic evaluation of immobility of normal and endometriotic ovary in detection of deep endometriosis. B. Gerges, C. Lu, S. Reid, D. Chou, T. Chang and G. Condous. Ultrasound Obstet Gynecol 2017; 49: 793-8. Ultrasound Obstet Gynecol. 2017;49(6):695. DOI: https://doi.org/10.1002/uog.17508 Gupta D, Hull ML, Fraser I, Miller L, Bossuyt PM, Johnson N, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;4(4):Cd012165. DOI: https://doi.org/10.1002/14651858.CD012165