Thyroid dysfunction associated with gonadotropin-releasing hormone analogues: myth or reality?

Gonadotropin-releasing hormone analogues (GnRHas) are widely used across multiple clinical settings, including hormone-sensitive cancers, benign gynecological conditions, reproductive medicine and central precocious puberty. While the long-term endocrine adverse effects of these agents are well recognized and characterized, their impact on thyroid function remains remarkably underinvestigated in clinical practice.The complex interplay between sex steroids, immune regulation and thyroid homeostasis provides a strong biological rationale for hypothesizing an effect of GnRH-based treatment on thyroid function; however, current evidence is scarce and largely limited to anecdotal reports of autoimmune thyroid disorders and a small number of studies describing biochemical alterations in thyroid hormone parameters following GnRHas administration. While routine screening and monitoring of thyroid function cannot currently be recommended, targeted evaluation in selected individuals may be clinically appropriate.This commentary summarizes the available clinical evidence and discusses potential pathophysiological mechanisms linking GnRH-based treatment to thyroid dysfunction. Rather than providing definitive conclusions, this work aims to highlight an underrecognized endocrine safety issue and to encourage systematic investigation in this field.