Objective <p>To investigate the dynamic expression of T-cell immunoglobulin and mucin domain molecule-1 (TIM-1) in pulmonary tuberculosis (PTB) patients at various stages, and examine possible relationships with IFN-γ and IL-17, to elucidate the potential roles in PTB pathogenesis. In addition, we aimed to assess the feasibility of using TIM-1 combined with IFN-γ and IL-17 as a biomarker for PTB diagnosis.</p> Methods <p>Plasma samples were collected from 60 PTB patients, 50 latent tuberculosis infection (LTBI) patients, and 50 healthy controls at the First Affiliated Hospital of Xinjiang Medical University between February and November 2023. The concentrations of TIM- 1, IFN-γ, and IL-17 in plasma were quantified using ELISA. Correlation and Logistic regression analyses were conducted, followed by the construction of a predictive model.</p> Results <p>Significantly higher plasma concentrations of TIM-1 and IL-17 and reduced levels of IFN-γ were observed in PTB patients compared to LTBI subjects and healthy controls. A positive correlation was found between TIM-1 and IL-17 levels in PTB patients. Receiver operating characteristic (ROC) curve analysis demonstrated that TIM-1 exhibited moderate diagnostic performance, with a cutoff value of 22.3 pg·ml^− 1, whereas the reduction in IFN-γ level was not statistically significant. The constructed predictive model had a C-index of 78.8% and an area under the ROC curve of 0.79.</p> Conclusions <p>Plasma TIM-1 concentration was significantly elevated in PTB patients and non-significantly raised in LTBI suggesting possible roles in promoting inflammation and modulating Th17 responses, potentially influencing mycobacterial clearance and perhaps disease progression. This highlights the potential importance of TIM-1 in tuberculous inflammatory processes, immune regulation, and its utility in early diagnostics, suggesting it may be a novel therapeutic target in PTB. These findings are preliminary and require further validation in larger, multicenter studies.</p>