Iron Deficiency in Endocrine Diseases and the Therapeutic Role of Liposomal Iron: A Comprehensive Review

Iron deficiency (ID) represents one of the most prevalent nutritional disorders worldwide, affecting approximately 1.2 billion individuals. Beyond its well-established hematological consequences, emerging evidence demonstrates that ID profoundly impacts endocrine function across multiple organ systems. Iron serves as an essential cofactor for numerous enzymes involved in hormone synthesis, metabolism, and signaling pathways. This comprehensive review examines the bidirectional relationships between iron deficiency and endocrine pathologies, including thyroid disorders (hypothyroidism, Hashimoto's thyroiditis, thyroid peroxidase impairment), diabetes mellitus (types 1 and 2), obesity, Polyendocrine Metabolic Ovarian Syndrome (PMOS), male hypogonadism, adrenal insufficiency, growth hormone deficiency, pituitary dysfunction, and parathyroid disorders. We systematically analyze the molecular mechanisms linking iron metabolism to endocrine dysfunction, with particular emphasis on thyroid peroxidase activity, insulin secretion and sensitivity, hepcidin regulation, testosterone synthesis, and cortisol production. Furthermore, we critically evaluate the therapeutic potential of liposomal iron supplementation, a novel delivery system that offers superior bioavailability and gastrointestinal tolerability compared to conventional oral iron formulations. Randomized controlled trials demonstrate that liposomal iron achieves comparable efficacy to intravenous iron while significantly reducing adverse events. This review synthesizes current evidence to provide clinicians with a comprehensive understanding of iron-endocrine interactions and evidence-based recommendations for iron supplementation in endocrine disorders. Recognition of these complex relationships is essential for optimizing diagnostic and therapeutic approaches in patients with concurrent iron deficiency and endocrine dysfunction.