Sexual Function and Depressive Symptoms in Premenopausal Women with Differentiated Thyroid Cancer: A Cross-Sectional Study

Abstract

Background:

Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy, disproportionately affecting women. Despite excellent survival outcomes, DTC treatment, particularly long-term thyrotropin (TSH) suppression therapy, has been associated with differences in psychological well-being and sexual function. Although the association between thyroid dysfunction and female sexual dysfunction (FSD) is well-established, limited data exist regarding FSD in premenopausal women with DTC.

Objective:

To investigate the presence and severity of depressive symptoms and FSD in premenopausal women with DTC and examine their association with thyroid hormone levels and thyroid autoimmunity.

Methods:

This cross-sectional study included 110 premenopausal women with DTC on stable TSH suppression therapy, stratified into three groups by TSH level (<0.1, 0.1–0.5, and 0.5–2.5 mIU/mL), and 40 healthy controls. Sexual function and depressive symptoms were assessed using the Female Sexual Function Index (FSFI) and Beck Depression Inventory-II (BDI-II), respectively. Thyroid function tests, thyroid antibodies, and sex hormones were evaluated. Correlation and logistic regression analyses were performed.

Results:

Women with DTC showed higher rates of sexual dysfunction and depressive symptoms than controls (FSD 53.6% vs. 10%; depressive symptoms 65.5% vs. 15%), with the greatest impairment under stronger TSH suppression. Increased BDI-II scores were inversely correlated with FSFI total and subdomain scores (desire, satisfaction, pain). TSH levels were positively associated with FSFI scores, while free thyroxine and free triiodothyronine showed inverse correlations with satisfaction and lubrication. Elevated thyroglobulin antibody levels were associated with higher depression scores. Multivariable models were adjusted for age. Covariates included body mass index, risk of recurrence, disease duration, TSH, free thyroxine, free triiodothyronine, thyroglobulin antibody, total testosterone, prolactin, and BDI-II. Logistic regression analysis showed that suppressed TSH and higher BDI-II scores were independently associated with higher odds of FSD.

Conclusions:

Sexual dysfunction and depressive symptoms were more frequent in women with DTC than in healthy controls; moreover, among women with DTC, the greatest deterioration was seen in those receiving stronger TSH suppression. These findings highlighted the need for comprehensive care that includes psychological and sexual health assessment in the long-term management of women with DTC.