Thyroid disorders, encompassing conditions like hypothyroidism and hyperthyroidism, remain enigmatic challenges in the realm of public health. These disorders exert profound effects on various physiological processes, making them a critical concern, particularly among women of reproductive age. The thyroid gland, nestled in the neck, plays a pivotal role in regulating metabolism, energy balance, and hormone production. Consequently, its proper functioning is paramount for overall well-being and reproductive health. The prevalence and potential health consequences of thyroid disorders have garnered increasing attention in recent years. Understanding the level of awareness and knowledge about thyroid disorders, especially among women of reproductive age, is pivotal. Informed individuals are more likely to seek timely medical attention, adopt preventive measures, and make informed decisions about their reproductive health [1-5].

The global significance of thyroid disorders is underscored by their substantial prevalence and far-reaching health implications. Hypothyroidism, characterized by an underactive thyroid gland, and hyperthyroidism, marked by an overactive thyroid gland, are two prominent thyroid disorders. These conditions can significantly affect women's reproductive health, potentially leading to menstrual irregularities, infertility, and complications during pregnancy. While medical science has made considerable strides in diagnosing and managing these disorders, the foundation of an effective approach lies in raising awareness and knowledge levels among the population [6-9].

District Shimla, nestled in the picturesque Himalayan landscape, presents a unique and captivating setting for investigating awareness levels of thyroid disorders among women of reproductive age. Despite its serene beauty, this region may pose challenges in terms of healthcare accessibility and awareness dissemination. Against this backdrop, understanding the extent of awareness and knowledge about thyroid disorders in this demographic becomes crucial.

This study aims to bridge this knowledge gap by comprehensively assessing the awareness and knowledge levels of women of reproductive age in District Shimla regarding thyroid disorders. We seek to uncover gaps in understanding and identify misconceptions, ultimately providing insights that can inform targeted awareness campaigns and educational interventions. Our endeavor is to empower women in District Shimla with the knowledge needed to make informed decisions about their thyroid health, reproductive well-being, and overall quality of life.

Objectives of the Study

To evaluate the awareness and knowledge regarding thyroid disorders, including hypothyroidism and hyperthyroidism among women of reproductive age in District Shimla.

Study Design and Setting

The research adopted a cross-sectional survey design and was conducted in District Shimla, known for its diverse population and urban lifestyle. Data collection and analysis took place over a period of three months, from April 2023 to July 2023.

Study Population and Sample Size

The target population comprised all reproductive age females who had been residing in District Shimla for at least 12 months. A sample size of 400 adults was determined using a confidence level of 95%, an estimated knowledge level of 50%, a 5% absolute error, and a 5% non-response rate, ensuring a representative sample.

Data Collection Tool

A validated Google Form questionnaire was developed, consisting of two sections. The first section gathered socio-demographic data, including age, marital status, religion, employment, and education. The second section comprised 20 carefully crafted questions to assess participants' knowledge about thyroid disorders, including hypothyroidism and hyperthyroidism. Correct responses were scored one mark, while incorrect answers received zero marks. Knowledge levels were categorized into four groups: very good (>80%), good (60-79%), fair (41-59%), and poor (<40%).

Data Collection

Experienced personnel supervised data collection to ensure accuracy and reliability. The Google Form questionnaire was distributed through various online platforms, including email, WhatsApp groups, Facebook, Instagram, and LinkedIn, to reach a diverse population in both rural and urban areas of District Shimla . Participants provided informed consent before inclusion, and their personal information was treated confidentially, adhering to strict ethical guidelines.

Data Analysis

 Data was entered into a Microsoft Excel spreadsheet and meticulously checked for accuracy and completeness. Epi Info V7 software was used for data analysis. Descriptive statistics, such as frequencies and percentages, were employed to present the findings concisely. The analysis aimed to identify knowledge levels and potential knowledge gaps related to thyroid disorders among women of reproductive age in District Shimla.

Ethical Considerations

Ethical considerations were paramount throughout the study. Informed consent was obtained from all participants, ensuring their voluntary involvement. To protect privacy and confidentiality, all data was anonymized and kept secure. The study adhered strictly to ethical guidelines for research involving human participants, fostering trust and respect between researchers and the study population.

The study aimed to gain insights into the awareness and knowledge of thyroid disorders within this demographic, shedding light on their understanding of these conditions, their symptoms, and potential risk factors.

A total of 400 respondents participated in the study, comprising 259 individuals (64.75%) from urban areas and 141 individuals (35.25%) from rural areas of District Shimla.

In the present study 29.5% (118)  participants had very good knowledge (16-20 marks) towards thyroid disorders, including hypothyroidism and hyperthyroidism , 39.25% (157) had good knowledge (12-15 marks), 18.5% (74) had fair knowledge  (8-11 marks) and 12.75% (51) having poor knowledge (<8 marks).

Table 1: Knowledge Regarding Thyroid Disorders among Study Participants

Figure 1: Knowledge Scores towards Thyroid Disorders among Study Participants

Thyroid disorders, comprising hypothyroidism and hyperthyroidism, are complex conditions with significant implications for women's health, particularly those of reproductive age. This study aimed to assess the awareness and knowledge levels of women in District Shimla regarding thyroid disorders, shedding light on their understanding of these conditions, their symptoms, and potential risk factors.

The study included 400 respondents, providing a comprehensive view of the knowledge landscape related to thyroid disorders in this demographic. The findings highlight several key points:

• Definition and Differentiation: Approximately 60.25% of participants could define both hypothyroidism and hyperthyroidism and distinguish between them. This foundational knowledge is crucial, as it forms the basis for understanding these conditions and their potential impact on health

• Thyroid Hormone Function: While 53.75% of respondents identified the main hormone produced by the thyroid gland and its role in the body, there is room for improvement in this aspect. A deeper understanding of thyroid hormones and their functions can empower individuals to make informed decisions about their health

• Symptom Recognition: Knowledge of common symptoms of hypothyroidism (54.5%) and hyperthyroidism (35.5%) was notable. Recognizing these symptoms is vital for early detection and timely medical intervention

• Risk Factors: Only 23.75% could identify risk factors associated with thyroid disorders, indicating a knowledge gap in understanding potential triggers for these conditions. Raising awareness of risk factors can help individuals make lifestyle adjustments and seek preventive measures

• Diagnosis and Tests: A majority (57.5%) knew how thyroid disorders are diagnosed and the typical tests conducted. This knowledge is critical for individuals seeking medical evaluation and diagnosis

• TSH and Hormone Levels: Understanding of TSH (thyroid-stimulating hormone) and its relation to thyroid disorders was limited (24.75%). Similarly, comprehension of thyroid hormone levels (T3, T4) and their impact on these conditions was relatively low (23.5%). Enhancing knowledge in these areas can contribute to better-informed healthcare decisions

• Impact of Untreated Disorders: A substantial number (40%) recognized the potential health consequences of untreated thyroid disorders, emphasizing the importance of early detection and treatment

• Demographic Factors: Approximately 45.25% were aware that thyroid disorders may vary in prevalence among different age groups and genders. This awareness can guide healthcare-seeking behaviors and risk assessments

• Lifestyle Factors and Medications: Knowledge regarding the influence of diet and exercise on thyroid health (36%) and familiarity with medications for thyroid disorders (39.5%) were moderate. Enhancing this knowledge can promote healthier lifestyles and adherence to prescribed treatments

• Natural and Alternative Treatments: A relatively low percentage (21.5%) recognized the existence of natural or alternative treatments for thyroid disorders. This aspect warrants further education and exploration of complementary approaches to thyroid health

• Complications of Untreated Disorders: Knowledge of potential complications resulting from untreated thyroid disorders was observed in 32% of participants, emphasizing the need for timely medical intervention

• Global Prevalence: Approximately 30.75% correctly identified that the prevalence of hypothyroidism or hyperthyroidism varies worldwide. Understanding the global context of these disorders can provide valuable perspective

• Autoimmune Diseases and Iodine: Knowledge of autoimmune diseases associated with thyroid disorders (16.5%) and the role of iodine in thyroid health (19%) was relatively low. Increased awareness in these areas can help individuals make informed dietary choices and understand their susceptibility to thyroid disorders

• Stress and Mental Health: Understanding the impact of stress and mental health on thyroid function was observed in 25.25% of participants. Recognizing the interplay between psychological well-being and thyroid health is essential for holistic healthcare

• Genetic Component: Approximately 21% were aware of the genetic component and family history relevance in thyroid disorders. This awareness can prompt individuals with family histories of thyroid conditions to be proactive about their health

• Importance of Regular Testing: A substantial majority (57%) understood the importance of regular thyroid function testing for individuals at risk of thyroid disorders. This awareness is crucial for early detection and management

Comparing these findings with studies conducted in similar settings and populations, it is evident that District Shimla's women of reproductive age display a moderate level of awareness about thyroid disorders.^9-14 However, specific knowledge gaps exist, particularly regarding the symptoms of hyperthyroidism, risk factors, lifestyle influences, and alternative treatments. These areas present opportunities for tailored educational interventions.

In summary, the study revealed both positive aspects and knowledge gaps related to thyroid disorders among women of reproductive age in District Shimla. While there is commendable awareness in various domains, including symptom recognition and diagnosis, there are opportunities for improvement in areas such as understanding thyroid hormone functions, risk factors, and the role of iodine. Addressing these knowledge gaps through targeted educational initiatives can empower women to make informed decisions about their thyroid health, reproductive well-being, and overall quality of life. These findings serve as a foundation for public health interventions aimed at enhancing thyroid disorder awareness in the region.

In conclusion, this study sheds light on the knowledge levels of women of reproductive age in District Shimla regarding thyroid disorders. While a significant proportion demonstrated good to very good knowledge, specific areas need attention and improvement. Addressing these knowledge gaps through targeted awareness campaigns and educational initiatives could empower women to take proactive steps in managing their thyroid health, ultimately leading to better reproductive well-being and overall quality of life.

1. Garber, J.R. et al. "Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Thyroid, vol. 22, no. 12, 2012, pp. 1200–1235.

2. Bahn, R.S. et al. "Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists." Thyroid, vol. 21, no. 6, 2011, pp. 593–646.

3. De Groot, L. et al. "Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline." Journal of Clinical Endocrinology & Metabolism, vol. 97, no. 8, 2012, pp. 2543–2565.

4. Casey, B.M. et al. "Subclinical hypothyroidism and pregnancy outcomes." Obstetrics and Gynecology, vol. 105, no. 2, 2005, pp. 239–245.

5. Hollowell, J.G. et al. "Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)." Journal of Clinical Endocrinology & Metabolism, vol. 87, no. 2, 2002, pp. 489–499.

6. Surks, M.I. et al. "Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management." JAMA, vol. 291, no. 2, 2004, pp. 228–238.

7. Alexander, E.K. et al. "2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum." Thyroid, vol. 27, no. 3, 2017, pp. 315–389.

8. Sinha, R. and S. Singh. "Thyroid disorders in pregnancy: An overview." International Journal of Scientific Study, vol. 3, no. 10, 2015, pp. 46–50.

9. World Health Organization. Reproductive health. World Health Organization, 2021, https://www.who.int/news-room/fact-sheets/detail/reproductive-health.

10. Singh, A. and S. Maharjan. "Knowledge of thyroid disorders among female college students in Kathmandu Valley." Journal of Kathmandu Medical College, vol. 7, no. 3, 2018, pp. 121–125.

11. 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. 17, no. 4, 2013, pp. 647–652.

12. Stagnaro-Green, A. "Maternal thyroid disease and preterm delivery." Journal of Clinical Endocrinology & Metabolism, vol. 94, no. 1 Suppl, 2009, pp. 21–25.

13. Asvold, B.O. et al. "Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: A population-based study." Journal of Clinical Endocrinology & Metabolism, vol. 92, no. 3, 2007, pp. 841–845.