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<p>Autoimmune thyroid diseases (ATDs), primarily including Hashimoto’s thyroiditis and Graves’ disease, are among the most common endocrine disorders and are characterised by a marked sexual dimorphism, with a clear female predominance (female-to-male ratio up to 10:1). Genetic, epigenetic, hormonal, and socio-environmental factors related to sex and gender influence susceptibility to the development of autoimmune thyroid disorders, contributing to this sex-based disparity. At the same time, gender – understood as a sociocultural construct – is an important determinant of environmental exposure to various autoimmune triggers, contributing to this dimorphism. It also influences disease diagnosis and management: women are more likely to access healthcare services and undergo screening, whereas men more frequently experience diagnostic delays. This review examines the main determinants of sex and gender differences in autoimmune thyroid diseases, with particular focus on the role of sex hormones, sex chromosomes, epigenetic mechanisms, environmental exposures, and the gut microbiota. The clinical implications of these differences and future perspectives for a precision medicine approach based on gender medicine – aimed at ensuring equity and accuracy in the management of ATDs – are also discussed.</p>

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Differenze di sesso e genere nelle malattie autoimmuni della tiroide: meccanismi patogenetici e implicazioni cliniche

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Rosaria M. Ruggeri,
  • Rosina Scala

摘要

Autoimmune thyroid diseases (ATDs), primarily including Hashimoto’s thyroiditis and Graves’ disease, are among the most common endocrine disorders and are characterised by a marked sexual dimorphism, with a clear female predominance (female-to-male ratio up to 10:1). Genetic, epigenetic, hormonal, and socio-environmental factors related to sex and gender influence susceptibility to the development of autoimmune thyroid disorders, contributing to this sex-based disparity. At the same time, gender – understood as a sociocultural construct – is an important determinant of environmental exposure to various autoimmune triggers, contributing to this dimorphism. It also influences disease diagnosis and management: women are more likely to access healthcare services and undergo screening, whereas men more frequently experience diagnostic delays. This review examines the main determinants of sex and gender differences in autoimmune thyroid diseases, with particular focus on the role of sex hormones, sex chromosomes, epigenetic mechanisms, environmental exposures, and the gut microbiota. The clinical implications of these differences and future perspectives for a precision medicine approach based on gender medicine – aimed at ensuring equity and accuracy in the management of ATDs – are also discussed.