Thyroid disorders, encompassing conditions such as hypothyroidism and hyperthyroidism, pose significant health challenges globally, impacting millions of lives and affecting various physiological processes. The prevalence of thyroid disorders is influenced by a myriad of factors, including geographical location, lifestyle and genetic predispositions. In the unique context of Himachal Pradesh, a state nestled in the pristine Himalayan region, understanding the awareness and knowledge levels concerning thyroid disorders becomes crucial for informed public health interventions.

Globally, thyroid disorders contribute significantly to the burden of disease, prompting health organizations, such as the World Health Organization [1], to recognize their importance [1]. The intricate interplay between environmental factors, dietary habits and thyroid health is acknowledged in studies like Hollowell et al. [2] and Zimmermann and Boelaert [3]. These underline the global significance of comprehending public awareness and knowledge regarding thyroid disorders to implement targeted preventive measures.

Within India, thyroid disorders are emerging as a substantial public health concern, affecting individuals across diverse demographic and geographic settings [4]. The epidemiological transition, coupled with lifestyle changes, has led to an increasing prevalence of thyroid disorders, as highlighted by studies such as Marwaha et al. [5] and Gopinath et al. [6]. Exploring the awareness levels and knowledge among the general public is pivotal to design context-specific interventions tailored to the unique healthcare challenges faced by different regions.

Himachal Pradesh, characterized by its distinct topography, cultural richness and unique lifestyle patterns, presents an intriguing setting for investigating thyroid disorders. The impact of altitude, dietary practices and genetic factors on thyroid health in the Himalayan region is a domain that warrants comprehensive exploration. While existing studies, such as those by Marwaha et al. [7] and Pandey et al. [8], lay the groundwork, there remains a need to delve deeper into the nuanced aspects of thyroid disorders awareness and knowledge in the state.

This study's inception is rooted in the imperative to bridge existing knowledge gaps pertaining to thyroid disorders among the general public of Himachal Pradesh. A nuanced understanding of the population's awareness levels is indispensable for developing targeted educational campaigns, fostering early detection and formulating strategies for effective management [9]. The dynamic interaction between genetic predispositions and environmental factors makes such studies essential for informing evidence-based healthcare policies.

The outcomes of this study are poised to significantly contribute to the understanding of thyroid disorders in the unique Himalayan setting. Insights derived from national studies, such as those conducted by Unnikrishnan et al. [4] and Marwaha et al. [5], will be instrumental in tailoring interventions that align with the diverse healthcare needs of Himachal Pradesh. The study not only aims to enrich the regional comprehension of thyroid disorders but also endeavors to pave the way for informed public health strategies that resonate with the distinctive cultural and environmental aspects of the state.

Embarking on this exploration, we aspire to unravel the intricacies of thyroid awareness in the Himalayas, fostering a foundation for targeted interventions that empower communities in Himachal Pradesh to navigate the thyroid tides effectively.

Objectives of the Study

To evaluate the awareness and knowledge regarding thyroid disorders, including hypothyroidism and hyperthyroidism among the general public of Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: Himachal Pradesh

• Study duration: Between August 2023 to November 2023

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of Himachal Pradesh for a minimum of 12 months

• Sample size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding thyroid disorders, including hypothyroidism and hyperthyroidism, a precise 5% absolute error margin and a conservative 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding thyroid disorders, including hypothyroidism and hyperthyroidism was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool 

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding thyroid disorders, including hypothyroidism and hyperthyroidism. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79%(12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of tool: By the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The goal of the current study was to assess general public knowledge regarding thyroid disorders, including hypothyroidism and hyperthyroidism through a non-experimental descriptive survey. A total of 400 respondents including 218 (54.5%) Male patients and 182 (45.5%) female patients were participated in the study. Among the total, 139 (34.75%) were from urban area and 261 (65.25%) were from rural area (Table 1).

In the present study 27.25% (109) participants had very good knowledge (16-20 marks) towards thyroid disorders, including hypothyroidism and hyperthyroidism, 37% (148) had good knowledge (12-15 marks), 21.75% (87) had fair knowledge (8-11 marks) and 14% (56) having poor knowledge (<8 marks) (Table 2).

The findings of this study offer valuable insights into the awareness and knowledge levels regarding thyroid disorders, encompassing hypothyroidism and hyperthyroidism, among the general public in Himachal Pradesh. This discussion contextualizes and analyzes the study results within the broader framework of global, national and regional perspectives on thyroid disorders awareness and knowledge.

Table 1: Knowledge Regarding Thyroid Disorders Among Study Participants

Table 2: Knowledge Score Regarding Thyroid Disorders Among Study Participants

Globally, thyroid disorders significantly contribute to the burden of disease and their impact on public health necessitates a nuanced understanding of awareness and knowledge levels [1]. Similar sentiments are echoed by studies such as Hollowell et al. [2] and Zimmermann and Boelaert [3], emphasizing the need for tailored preventive measures based on comprehensive awareness. In the Indian context, Unnikrishnan et al. [4], Marwaha et al. [5] and Gopinath et al. [6] highlight the increasing prevalence of thyroid disorders, underscoring the importance of studies addressing awareness and knowledge gaps.

Himachal Pradesh, with its unique topography and cultural richness, presents a distinctive context for understanding thyroid disorders. While studies like Marwaha et al. [7], Pandey et al. [8], Thakur et al. [10] and Verma et al. (2021)11 provide foundational insights, the current study contributes to the understanding of nuanced aspects of thyroid disorders awareness and knowledge specific to this Himalayan region.

Comparing our findings with existing literature reveals a substantial level of knowledge among participants. Notably, 61.5% correctly identified the differences between hypothyroidism and hyperthyroidism and 58.75% understood the role of TSH in these conditions. This aligns with Ladenson et al. [9], emphasizing the importance of public knowledge in thyroid management.

One notable finding is the varying levels of knowledge among participants. While 27.25% demonstrated very good knowledge and 37% exhibited good knowledge, a significant proportion had fair 21.75% or poor knowledge 14%. This highlights the existence of knowledge gaps that need targeted educational interventions.

While participants showed commendable awareness in some areas, such as the impact of untreated thyroid disorders 40.75% and the necessity of regular thyroid function testing 58.25%, other areas, including identifying medications for treatment 40.25% and the association of autoimmune diseases 16.75%, reveal specific knowledge gaps. These gaps indicate the need for tailored awareness campaigns addressing these specific aspects.

The study outcomes carry direct implications for public health initiatives in Himachal Pradesh. Designing interventions that build on existing awareness while addressing identified gaps is crucial. Insights from studies by Ladenson et al. [9], Marwaha et al. [7] and Unnikrishnan et al. [4] support the notion that community-based education can significantly contribute to enhancing thyroid awareness and preventive practices.

Limitations and Future Directions

Acknowledging the limitations of the study, such as the reliance on online data collection and the cross-sectional design, future research could delve deeper into the effectiveness of community-based educational programs in improving thyroid knowledge. Additionally, longitudinal studies could explore the sustained impact of such interventions on preventive behaviors.

In conclusion, this study provides a comprehensive overview of thyroid disorders awareness and knowledge among the general public in Himachal Pradesh. The findings contribute not only to the regional understanding but also lay the groundwork for targeted public health interventions. Addressing the identified knowledge gaps can empower communities to navigate the complexities of thyroid disorders effectively and promote overall thyroid health in the Himalayan region.

1. World Health Organization. Micronutrients: Iodine. 2021, https://www.who.int/news-room/questions-and-answers/item/micronutrient-deficiencies

2. Hollowell, J.G. et al. “Iodine nutrition in the united states: trends and public health implications: iodine excretion data from national health and nutrition examination surveys I and III (1971–1974 and 1988–1994).” JCEM, vol. 87, no. 12, 2002, pp. 5395–5402.

3. Zimmermann, M.B. et al. “Iodine deficiency and thyroid disorders.” The Lancet Diabetes and Endocrinology, vol. 3, no. 4, 2015, pp. 286–295.

4. Unnikrishnan, A.G. et al. “Prevalence of hypothyroidism in adults: an epidemiological study in eight cities of India.” Indian Journal of Endocrinology and Metabolism, vol. 18, no. 6, 2014, p. 830.

5. Marwaha, R.K. et al. “Impact of population iodine status on prevalence of goiter and thyroid dysfunction in schoolchildren from northern India.” The Indian Journal of Endocrinology and Metabolism, vol. 15, no. 4, 2011, p. 309.

6. Gopinath, G. et al. “Prevalence of thyroid disorders among college going girls.” International Journal of Contemporary Medical Research, vol. 6, no. 6, 2019, pp. J6–J9.

7. Marwaha, R.K. et al. “Residual goitre in the postiodization phase: iodine status, thiocyanate exposure and autoimmunity.” Clinical Endocrinology, vol. 86, no. 6, 2017, pp. 845–852.

8. Pandey, D. et al. “Assessment of prevalence and risk factors of thyroid dysfunction in Himachal Pradesh, India.” International Journal of Medical Science and Public Health, vol. 7, no. 4, 2018, pp. 280–284.

9. Ladenson, P.W. et al. “American thyroid association guidelines for detection of thyroid dysfunction.” Archives of Internal Medicine, vol. 160, no. 11, 2000, pp. 1573–1575.

10. Thakur, J.S. et al. “Profile of risk factors and micronutrient deficiency among the infants of shimla district: A community-based study.” Indian Journal of Community Medicine, vol. 45, no. 3, 2020, p. 354.

11. Verma, R. et al. “Knowledge, attitude and practices regarding thyroid disorders in a hilly state of north India: A cross-sectional study.” Thyroid Research and Practice, vol. 18, no. 1, 2021, pp. 26–30.