Endocrine and cardiovascular consequences of plasticiser exposure: a narrative review from the thyroid- cardiac axis...

Endocrine-disrupting chemicals particularly plasticisers such as phthalates, bisphenols and their emerging substitutes, are increasingly recognised as the main environmental toxicants with significant implications for thyroid and cardiovascular health. Due to their widespread use in consumer products, food packaging, medical devices, cosmetics and industrial materials, chronic human exposure occurs via ingestion, inhalation, dermal absorption and parenteral administration. Increasing evidence indicates that these compounds disrupt the hypothalamic-pituitary-thyroid axis by interfering with thyroid hormone synthesis, transport, receptor signalling, iodine homeostasis and endocrine feedback regulation. These disruptions contribute to thyroid autoimmunity, hypothyroidism, and broader endocrine imbalance. Because tfundihyroid hormones are vital for cardiovascular health, plasticiser-related thyroid problems can indirectly lead to cardiovascular issues, including hypertension, endothelial dysfunction, dyslipidaemia, arrhythmias, atherosclerosis and heart failure. Mechanistically, these effects are mediated by oxidative stress, mitochondrial dysfunction, inflammatory signalling, ion-channel disruption, metabolic dysregulation and epigenetic modifications. Integrated thyroid-cardiac crosstalk is increasingly recognised as a critical mechanistic axis linking environmental EDC exposure to the progression of cardiometabolic disease. The review highlights the emerging biomarkers and advanced microfluidic and organ-on-chip technologies as promising tools for early detection and mechanistic evaluation of plasticiser-induced thyroid-cardiac dysfunction. Collectively, this review also highlights the critical need for long-term human studies, combined exposure assessments and translational diagnostic approaches to enhance our understanding and alleviate the escalating public health burden of environmental plasticiser exposure.