Diagnosis and Management of Hypothyroidism: Addressing the Knowledge-Action Gaps

Knowledge of Thyroid Disease Manifestation and Risk Factors Among the General Population in the Tabuk Region of Saudi Arabia

Background Thyroid disorders are caused either by excessive or inadequate thyroid hormone production or by the enlargement of the thyroid gland. Various types of thyroid disorders exist, including primary (related directly to the gland itself), secondary (related to thyroid function), and other types. This study aimed to assess the knowledge of thyroid disease manifestation and its risk factors among individuals living in Tabuk, Saudi Arabia. Methodology An observational cross-sectional study was conducted among 400 adults living in Tabuk city of Saudi Arabia aged 18 years or above. Data was collected using an electronic questionnaire through a simple random sampling method. Data was then coded, entered, and analyzed using both descriptive and inferential statistical methods using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results A total of 403 participants were enrolled in this study. More than half (n=265, 65.8%) were females, and 188 (46.7%) were in the age group of 18-35 years. The educational level of the majority of them was a bachelor's degree (n=296, 73.4%). Hypothyroidism was the most common thyroid disorder among family members (n=51, 62.4%). Inadequate iodine intake was thought to be a risk factor for thyroid disorders, as mentioned by 276 (68.5%) participants. Exact 284 (70.5%) participants believed that females are more at risk of having thyroid disease. The mean total knowledge score was found to be 25.1±4.48 out of a total of 34. Exact 216 (53.6%) participants had good knowledge about thyroid disorders. The female gender had significantly higher levels of knowledge as compared to males (p-value=0.002) regarding the manifestation and risk factors of thyroid disorders. In terms of educational level, a bachelor's or above was found to be significantly associated with a higher level of knowledge (p-value=0.003). Conclusion A good level of knowledge and awareness about thyroid disorders was observed among more than half of the participants. Few knowledge gaps were identified regarding knowledge about symptoms of hypothyroidism and certain medications which might cause thyroid disorders.

Low awareness and under-diagnosis of hypothyroidism

Hypothyroidism is a common condition with a prevalence that varies according to local dietary iodine availability, gender and age. The symptoms of hypothyroidism are generally nonspecific, with considerable overlap with other conditions and with the consequences for the health of advancing age. These symptoms are not useful for diagnosing hypothyroidism and a thyroid function test is required for a firm clinical diagnosis. Lack of knowledge and understanding of hypothyroidism, and a tendency for many people to attribute the symptoms of hypothyroidism to other causes have led to substantial unawareness and often late diagnosis of hypothyroidism. Large observational studies and meta-analyses have shown that about 4-7% of community-derived populations in the USA and Europe have undiagnosed hypothyroidism. About four cases in five of these are subclinical hypothyroidism, with the remainder being overt hypothyroidism. The prevalence of undiagnosed hypothyroidism is higher in older subjects, in women, and some ethnic groups, consistent with diagnosed disease. More research is needed to quantify the clinical burden of undiagnosed hypothyroidism around the world, with educational efforts aimed at the public and healthcare professionals aimed at identifying and managing these individuals.