Thyroid disorders are among the most common endocrine disorders worldwide, significantly impacting individuals' health and quality of life. The thyroid gland, a small but vital endocrine organ, plays a critical role in regulating metabolism, growth, and development through hormone production. Disruptions in thyroid function can lead to a range of conditions, including hypothyroidism, hyperthyroidism, goiter, and thyroid nodules, which, if left undiagnosed or untreated, may result in severe complications such as cardiovascular disease, infertility, and impaired cognitive function. Despite their prevalence, thyroid disorders often remain underdiagnosed, particularly in underserved or geographically isolated regions.[1-5]

Shimla, the capital of Himachal Pradesh, provides a unique context for studying thyroid disorder awareness. The region’s diverse demographic and socio-economic profile, coupled with its high-altitude location, poses distinctive health challenges. Iodine deficiency, a significant contributor to thyroid disorders, has been historically prevalent in hilly regions, making public knowledge and awareness essential for effective prevention and management. Moreover, access to healthcare and diagnostic services in Shimla varies significantly between urban and rural areas, potentially influencing awareness levels and treatment-seeking behavior.

Public awareness of thyroid disorders encompasses knowledge about symptoms, risk factors, available treatment options, and the importance of early diagnosis. However, misinformation, stigma, and limited access to reliable health information often hinder timely intervention. Previous studies suggest that gaps in public understanding of thyroid disorders can lead to delayed treatment, worsening outcomes, and increased healthcare burdens. Factors such as education level, gender, socio-economic status, and cultural beliefs further shape perceptions and practices surrounding thyroid health.

This study aims to assess public knowledge regarding thyroid disorders and treatment options among residents of Shimla. By exploring awareness levels and identifying knowledge gaps, the study seeks to provide evidence-based insights for designing targeted health education initiatives and improving access to diagnostic and treatment facilities. In doing so, the research aspires to contribute to the broader goal of reducing the prevalence and impact of thyroid disorders in the region and enhancing the overall health and well-being of Shimla's residents.

Aims and Objectives

Aims:

To evaluate public knowledge and awareness regarding thyroid disorders and treatment options among the residents of Shimla, with a focus on identifying knowledge gaps and socio-demographic factors influencing understanding. This study aims to provide actionable insights for the development of targeted health education initiatives and strategies to enhance awareness, early diagnosis, and effective management of thyroid disorders in the region.

Objectives:

1. To assess the level of awareness among residents about thyroid disorders, including their causes, symptoms, and risk factors.

2. To evaluate public knowledge of diagnostic methods and available treatment options for thyroid disorders.

3. To identify misconceptions or barriers that hinder early diagnosis and effective treatment-seeking behavior.

4. To provide recommendations for improving public knowledge and accessibility to healthcare services for thyroid disorders.

Research Approach:

This was a descriptive cross-sectional study aimed at evaluating the awareness and understanding of thyroid disorders among residents of Shimla.

Research Design:

A community-based cross-sectional survey design was employed to capture a snapshot of the public's knowledge and awareness regarding thyroid disorders and treatment options.

Study Area:

The study was conducted in Shimla, Himachal Pradesh, encompassing both urban and rural regions to ensure diverse representation.

Study Duration:

The study was carried out over three months, from August 2024 to October 2024.

Study Population:

The target population comprised adults aged 18 and above who had been residents of Shimla for at least one year. The inclusion of both urban and rural residents ensured a representative sample reflecting Shimla's socio-demographic diversity.

Sample Size:

Based on a 95% confidence level, a 50% estimated awareness level regarding thyroid disorders, and a 5% margin of error, a sample size of 400 participants was determined. An additional 5% was factored in to account for non-responses, ensuring robust data collection.

Study Tool:

A structured questionnaire was developed for data collection. The questionnaire was divided into two sections:

1. Socio-Demographic Information: Included variables such as age, gender, education, occupation, area of residence (urban/rural), and duration of residence in Shimla.

2. Thyroid Knowledge Assessment: Included 20 structured questions covering topics such as:

• Basic thyroid gland function.

• Common thyroid disorders (hypothyroidism, hyperthyroidism, goiter, thyroid nodules).

• Symptoms and risk factors of thyroid disorders.

• Awareness of diagnostic methods (e.g., blood tests, ultrasound).

• Knowledge of treatment options (e.g., medication, surgery, dietary interventions).

• Misconceptions and barriers to diagnosis or treatment.

Each correct answer was awarded one point, with total scores categorized as:

• Very Good (>80%): 16-20 points

• Good (60-79%): 12-15 points

• Fair (41-59%): 8-11 points

• Poor (<40%): <8 points

The questionnaire was pre-tested on a small sample to ensure reliability and clarity and reviewed by healthcare professionals specializing in endocrinology.

Data Collection:

• Data were collected via a Google Forms-based survey, distributed through online platforms such as WhatsApp, Facebook, and Instagram to maximize reach across urban and rural populations.

• Responses were collected until the target sample size of 400 was achieved.

Data Analysis:

• Collected data were organized and cleaned using Microsoft Excel.

• Statistical analysis was performed using Epi Info V7 software, including:

  • Frequency and percentage distribution for socio-demographic variables.

  • Descriptive statistics for awareness scores.

  • Cross-tabulation to explore correlations between socio-demographic factors and knowledge levels.

Ethical Considerations:

• Participation was voluntary, with informed consent obtained from all respondents.

• Confidentiality and anonymity of participants were maintained, with no identifying information recorded.

• The study adhered to ethical guidelines for research involving human participants, and participants were informed of their right to withdraw at any time.

The aim of this study was to evaluate public knowledge and awareness regarding thyroid disorders, including understanding of their causes, symptoms, diagnostic methods, and treatment options. A total of 400 participants from Shimla, Himachal Pradesh, participated in the study, providing a comprehensive dataset for analysis.

The socio-demographic profile of the study participants reveals a balanced representation of Shimla's population, with 47.25% male and 52.75% female respondents. Most participants (33.50%) were in the 26–35 age group, followed by 25.75% in the 36–45 range, while those aged 56 and above accounted for only 2.50%. Educational attainment varied, with 36.75% having an undergraduate degree, while 7.00% had no formal education. Rural residents constituted the majority at 65.25%, reflecting Shimla's demographic distribution. This diverse participant pool provided a robust foundation for evaluating knowledge levels across different age, gender, education, and geographic categories.

Table 1: Socio-Demographic Profile of Study Participants

The assessment of participants' knowledge of thyroid disorders showed varying levels of awareness across topics. While 51.00% correctly identified common thyroid disorders, only 48.25% understood the gland's primary function, and awareness of symptoms like hypothyroidism (37.00%) and hyperthyroidism (44.25%) was moderate. Preventive knowledge was stronger, with 56.25% aware of iodine’s role in thyroid health and 52.00% knowing iodine-rich foods. Diagnostic awareness was moderate (46.50%), as was understanding of treatment options (42.75%). Specific areas like thyroid cancer symptoms (35.75%) and government programs (43.00%) revealed notable gaps, underscoring the need for targeted education.

Table 2: Knowledge Regarding Thyroid Disorders among Study Participants

Participants’ knowledge scores revealed that only 22.75% demonstrated a very high level of awareness, scoring in the "Very Good" category, while 35.75% scored "Good," indicating moderate understanding. A significant portion (32.50%) had limited awareness, scoring "Fair," and 9.00% showed minimal knowledge, categorized as "Poor." This distribution highlights uneven knowledge levels, with the majority of participants falling short of comprehensive understanding, particularly regarding advanced concepts and treatment options, emphasizing the importance of focused public health education initiatives to address these gaps.

Figure-1: Distribution of Knowledge Scores on Thyroid Disorders

The findings of this study offer a comprehensive overview of public knowledge and awareness regarding thyroid disorders and treatment options among residents of Shimla, Himachal Pradesh. The socio-demographic profile highlights the diverse characteristics of the study population, with females (52.75%) slightly outnumbering males (47.25%). The majority of participants were in the 26–35 age group (33.50%), followed by the 36–45 age group (25.75%), while older adults aged 56 and above constituted only 2.50%. Educational attainment showed considerable variation, with 36.75% holding undergraduate degrees and 7.00% having no formal education. Additionally, a significant proportion of participants (65.25%) resided in rural areas, reflecting Shimla's predominantly rural demographic. This diversity in age, education, and geography underscores the importance of examining how these socio-demographic factors influence awareness and understanding of thyroid disorders.

The knowledge assessment revealed a mix of foundational understanding and critical gaps. While over half of the participants (51.00%) were able to identify common thyroid disorders such as hypothyroidism, hyperthyroidism, and goiter, only 48.25% understood the thyroid gland’s primary role in regulating hormones and metabolism. Symptom awareness varied widely, with 37.00% recognizing hypothyroidism symptoms like fatigue, weight gain, and cold sensitivity, and 44.25% identifying hyperthyroidism symptoms such as weight loss, tremors, and rapid heartbeat. These moderate levels of awareness are concerning, as delayed recognition of thyroid symptoms can lead to severe complications, including cardiovascular diseases, infertility, and impaired cognitive function. Furthermore, while 56.25% of participants were aware of iodine’s role in thyroid health and 52.00% could identify iodine-rich foods, knowledge of diagnostic methods like TSH testing (46.50%) and treatment options (42.75%) was relatively limited. Advanced areas of knowledge, such as symptoms of thyroid cancer (35.75%) and awareness of government programs like the National Iodine Deficiency Disorders Control Program (43.00%), revealed substantial gaps, emphasizing the need for targeted education and outreach.

The distribution of knowledge scores paints a clearer picture of the uneven understanding of thyroid disorders among participants. While 22.75% scored in the "Very Good" category, reflecting comprehensive awareness, a larger proportion (35.75%) fell into the "Good" category, indicating moderate understanding. Alarmingly, 32.50% of participants were classified as "Fair," demonstrating limited awareness, and 9.00% were categorized as "Poor," revealing minimal knowledge. This distribution highlights a significant section of the population that is underserved in terms of thyroid health education. Rural residents, who formed the majority of the study population, and individuals with lower educational attainment were particularly vulnerable, reflecting the disparities in access to healthcare information and resources.[6,7]

These findings have critical implications for public health initiatives in Shimla. First, improving symptom recognition is vital to ensuring timely diagnosis and treatment, as early intervention can prevent severe complications associated with untreated thyroid disorders. Second, while awareness of iodine's role in thyroid health is encouraging, there is a need to reinforce preventive practices, such as promoting the consumption of iodine-rich foods like iodized salt and seafood, particularly in rural areas. Third, the gaps in understanding diagnostic methods and treatment options underscore the importance of community-level education campaigns that demystify available healthcare services, such as TSH testing, thyroid hormone replacement therapy, and surgical interventions. Fourth, public health programs must prioritize rural areas, leveraging local leaders, schools, and healthcare workers to improve outreach. Finally, the limited awareness of government initiatives, like the National Iodine Deficiency Disorders Control Program, indicates an urgent need to enhance the visibility of these programs through strategic partnerships and grassroots campaigns.[8-10]

While this study provides valuable insights into thyroid disorder awareness, it is important to acknowledge its limitations. The reliance on online platforms for data collection may have excluded individuals without internet access, potentially skewing the sample toward more educated and urban populations. Future research should incorporate in-person surveys and mixed-method approaches to capture a more inclusive representation, particularly of remote and underserved communities. Additionally, qualitative data collection, such as interviews or focus groups, could provide deeper insights into the cultural and social factors influencing thyroid health awareness.

In conclusion, this study underscores both the foundational knowledge and the critical gaps in public awareness regarding thyroid disorders among Shimla residents. Although a portion of the population demonstrated moderate understanding, significant deficiencies remain in recognizing symptoms, understanding diagnostic tools, and being informed about treatment options. These gaps present an opportunity for targeted interventions, including educational programs tailored to different demographic groups, increased promotion of government health initiatives, and focused efforts to reach rural populations. By addressing these gaps, public health initiatives can empower Shimla’s residents with the knowledge and resources needed to prevent, diagnose, and manage thyroid disorders effectively, ultimately improving health outcomes and quality of life in the region.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Jawaharlal Nehru Medical College, Aligarh Muslim University(AMU).

1. Cleveland Clinic. "Thyroid Disease" Cleveland Clinic 16 Nov. 2024, https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease. Accessed 16 Nov. 2024.

2. WebMD. "Understanding Thyroid Problems: Basics" WebMD 16 Nov. 2024, https://www.webmd.com/women/understanding-thyroid-problems-basics. Accessed 16 Nov. 2024.

3. Chaker L., et al. "Hypothyroidism" The Lancet 390.10101 (2017) pp. 1550-1562. DOI: https://doi.org/10.1016/S0140-6736(17)31272-1.

4. Mayo Clinic. "Hypothyroidism: Symptoms and Causes" Mayo Clinic 16 Nov. 2024, https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284. Accessed 16 Nov. 2024.

5. MedlinePlus. "Hyperthyroidism" MedlinePlus 16 Nov. 2024, https://medlineplus.gov/hyperthyroidism.html. Accessed 16 Nov. 2024.

6. Abirami R. S., et al. "Knowledge and Awareness Regarding Thyroid Disorder Among Paramedical Students" International Journal of Community Medicine and Public Health 11 (2024) pp. 4280-4284. DOI: https://doi.org/10.18203/2394-6040.ijcmph20243861.

7. Raina S. "Endocrinology in the Hills of Himachal Pradesh, India" Indian Journal of Endocrinology and Metabolism 16.2 (2012) pp. 316-317. DOI: https://doi.org/10.4103/2230-8210.94417.

8. Rana S., et al. "Assess the Knowledge Regarding Thyroid Disorders Among Patients Attending Medical OPD" International Journal of Community Medicine and Public Health 11 (2024) pp. 4285-4289. DOI: https://doi.org/10.18203/2394-6040.ijcmph20243921.

9. Thakur K., and C. Pal. "Evaluation Regarding Causes, Symptoms, and Treatment Options for Thyroid Disorders Among the Patients Attending Outpatient Department of Civil Hospital Jogindernagar, Himachal Pradesh" Himalayan Journal of Applied Medical Sciences and Research 4.2 (2023) pp. 12-16. DOI: https://doi.org/10.47299/hjamsr.2023.v04i02.003.

10. ChitvanD., and D. Thakur. "Assessment of Awareness Regarding Thyroid Disorders Among General Population in the Northern Hilly City of Himachal Pradesh" IAR Journal of Medical Science 4.2 (2023) pp. 1-4. DOI: https://doi.org/10.47310/iarjms.2023.v04i02.001.