Thyroid disorders, encompassing conditions such as hypothyroidism, hyperthyroidism, and iodine deficiency-related diseases, represent a significant yet often overlooked public health concern globally. The thyroid gland plays a critical role in regulating metabolism, growth, and overall physiological balance through the secretion of thyroid hormones. Dysfunction of this small but vital gland can lead to a wide range of health issues, including weight fluctuations, cardiovascular abnormalities, mental health disturbances, infertility, and developmental problems in children. Alarmingly, thyroid diseases frequently remain undiagnosed due to their subtle, nonspecific symptoms, leading to delayed treatment and preventable complications[1-4]. India bears a substantial burden of thyroid disorders, with an estimated 42 million individuals affected, making it one of the largest populations impacted worldwide.            

Factors such as changing dietary patterns, inadequate iodine intake, autoimmune conditions, genetic predisposition, and environmental influences have contributed to the increasing prevalence. Despite government efforts to implement universal salt iodization and promote public health awareness, knowledge about thyroid health, the importance of iodine, and early recognition of thyroid dysfunctions remains fragmented, particularly in rural and semi-urban regions [5-7].

Shimla district of Himachal Pradesh, characterized by its diverse mix of rural and urban communities, presents an important setting for studying thyroid disorder awareness. Traditional dietary habits, varying iodine consumption levels, and limited access to specialized healthcare services could significantly influence the public’s perception and management of thyroid diseases. However, localized data assessing community knowledge, attitudes, and practices regarding thyroid health are scarce.

This study aims to systematically evaluate the awareness of thyroid disorders, public understanding of risk factors such as iodine deficiency, recognition of early signs and symptoms of hypothyroidism and hyperthyroidism, and prevalent misconceptions among the general population of Shimla district. By identifying knowledge gaps and misconceptions, the research seeks to inform targeted educational interventions and public health strategies to improve early diagnosis, promote adequate iodine intake, and reduce the overall burden   of   thyroid-related   diseases  in   the   region.

Study Design

This study employed a descriptive, cross-sectional survey design aimed at assessing public perception, knowledge, and awareness related to thyroid disorders, including hypothyroidism, hyperthyroidism, and iodine intake, among residents of Shimla district, Himachal Pradesh. A cross-sectional approach was chosen to capture a real-time snapshot of community-level understanding and practices regarding thyroid health.

Study Area and Population

The survey was conducted across urban, semi-urban, and rural populations within Shimla district, ensuring broad representation. The target population included adult residents aged 18 years and above, irrespective of their prior thyroid disease status. Practicing healthcare professionals were excluded to maintain the focus on general community awareness and perceptions.

Study Duration

Data collection was carried out over a three-month period, from January to March 2025, utilizing online platforms exclusively to ensure ease of access and wide reach across different demographic groups.

Sample Size and Sampling Technique

A total sample size of 400 participants was determined based on a 95% confidence level, a 5% margin of error, and an assumed 50% awareness prevalence of thyroid disorders due to a lack of prior localized data. Participants were selected using purposive and snowball sampling methods exclusively through online platforms. Initial participants were recruited through social media outreach (WhatsApp groups, Facebook communities), local forums, and email invitations, and were encouraged to circulate the survey link within their networks to expand participation.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Adults aged 18 years and above residing in Shimla district

• Ability to comprehend and respond to the survey in Hindi or English

• Access to an internet-enabled device (smartphone, tablet, or computer)

• Provision of informed online consent prior to participation

Exclusion Criteria

• Practicing healthcare professionals (such as doctors, nurses, pharmacists)

• Incomplete survey responses

Data Collection Tool

A structured, pre-validated, bilingual (Hindi and English) online questionnaire was developed after consultations with endocrinologists and public health experts. The questionnaire, administered through Google Forms, was designed to be mobile-friendly and accessible across devices. It comprised four major sections:

• Demographic Information – capturing age, gender, education level, occupation, and residential setting

• Knowledge Assessment – evaluating awareness regarding types of thyroid disorders, symptoms, risk factors (including iodine intake), complications, and preventive measures

• Detection and Management Practices – questions related to awareness about diagnosis, treatment adherence, and preventive health behaviors

• Beliefs and Misconceptions – identifying common myths and misconceptions related to thyroid health, iodine use, and self-care behaviors

Data Collection Procedure

Participants received a survey link via WhatsApp, Facebook groups, emails, and other local online networks. The introductory page of the survey included a clear description of the study’s objectives, confidentiality assurances, and instructions for voluntary participation. Only fully completed surveys were considered valid for analysis to ensure high-quality data.

Scoring and Data Classification

Each correct answer in the knowledge assessment was assigned one point, while incorrect or "don't know" responses received zero points. Participants' cumulative scores   were   categorized  into  four  levels   for  analysis:

•              Very Good Knowledge (≥80% correct responses)

•              Good Knowledge (60%–79% correct responses)

•              Fair Knowledge (41%–59% correct responses)

•              Poor Knowledge (<40% correct responses)

Participants’ practices and misconceptions were analyzed descriptively, with particular attention to behaviors affecting iodine consumption and early symptom recognition.

Data Analysis

Survey responses were downloaded from Google Forms, exported into Microsoft Excel, and cleaned for completeness and accuracy. Data were analyzed using SPSS version 26.0. Descriptive statistics, including frequencies, percentages, and means, were employed to summarize participant demographics, knowledge levels, practices, and belief patterns related to thyroid disorders.

Ethical Considerations

Prior to participation, all respondents provided online informed consent. Confidentiality and anonymity were strictly maintained, and no personally identifiable information was collected. Participants were informed of their right to withdraw from the study at any time without providing a reason.

The socio-demographic profile of the 400 participants revealed a predominantly young to middle-aged population, with 38.3% aged between 26–35 years, followed by 25.5% in the 36–45 years range, and 24.3% aged 18–25 years. A slight female predominance was observed, with females constituting 53.3% and males 46.8% of the sample. In terms of educational attainment, 36.3% of respondents had completed secondary school education, while 29.0% held undergraduate degrees, and 19.0% had primary education; only 7.3% reported no formal education. Regarding occupation, homemakers represented the largest group (34.8%), followed by self-employed individuals (21.5%) and students/unemployed respondents     (21.3%).   A     smaller    proportion   were government (11.8%) and private sector employees (10.8%). Residential distribution showed that 64.8% of participants resided in rural areas, compared to 35.3% living in urban settings, ensuring robust representation across various socio-economic and geographic backgrounds within Shimla district.

The assessment of thyroid disorder awareness among participants indicated moderately high knowledge levels, with 79.0% correctly identifying thyroid gland dysfunction as the basis of thyroid disorders and 75.8% recognizing weight gain as a symptom of hypothyroidism. Awareness of iodine's essential role in thyroid health was comparatively lower at 60.3%, indicating a critical gap. Participants demonstrated good recognition of hyperthyroidism symptoms such as rapid heartbeat (74.3%) and the importance of thyroid screening (81.0%). However, misconceptions persisted, with only 64.8% knowing that thyroid disorders cannot be completely cured and just 62.0% acknowledging the lifelong nature of thyroid medication in many cases. Awareness about complications such as infertility (66.8%), heart issues (71.0%), and mental health effects (68.0%) was moderate, and 79.8% understood the importance of iodized salt. Notably, 83.3% correctly identified endocrinologists or general practitioners as the appropriate professionals to diagnose thyroid disorders. Overall, while the knowledge base was encouraging, key gaps in understanding disease management, iodine significance, and symptom diversity were evident.

Based on cumulative knowledge scores, 30.5% of participants demonstrated a "Very Good" understanding (≥80% correct responses) of thyroid disorders, while 43.0% fell into the "Good" category (60%–79%), suggesting that over 70% of the population had a reasonably strong awareness. However, 19.5% of respondents displayed "Fair" knowledge (41%–59%) and 7.0% exhibited "Poor" knowledge (<40%), revealing that approximately one-fourth of the participants still lacked adequate understanding of thyroid disorders and their implications. These findings underscore the pressing need for targeted educational efforts to improve thyroid health literacy, particularly focusing on rural populations and  those with limited educational backgrounds.

Table 1: socio-demographic characteristics of participants

Table 2: awareness and knowledge of thyroid disorders among participants

Table 3: knowledge score classification

The present community-based cross-sectional study provides important insights into the current levels of awareness, knowledge, and perceptions regarding thyroid disorders among residents of Shimla district, Himachal Pradesh. The findings reflect a cautiously optimistic scenario, highlighting reasonably strong awareness about basic thyroid gland functions, disease symptoms, and preventive measures among the community, while simultaneously revealing critical gaps that could impede early diagnosis, timely intervention, and effective long-term management.

A major strength emerging from this study is the relatively high proportion of participants who correctly identified fundamental aspects of thyroid health. Notably, 79.0% recognized thyroid gland dysfunction as the cause of thyroid disorders, and 75.8% associated hypothyroidism with weight gain—both key indicators of general disease literacy. Furthermore, a commendable 81.0% acknowledged the importance of regular thyroid screening, and 82.0% emphasized the need for routine thyroid function testing, suggesting that public health messaging about disease detection has achieved considerable penetration. Awareness of complications such as infertility (66.8%), heart issues (71.0%), and mental health disturbances (68.0%) further reflects growing community understanding of the systemic consequences of thyroid dysfunction. Encouragingly, a significant majority (83.3%) correctly identified endocrinologists and general practitioners as the appropriate healthcare providers for diagnosing thyroid disorders, indicating a strong perception of the need for professional medical evaluation.

Despite these promising findings, several critical knowledge gaps and misconceptions persist that merit urgent attention. Alarmingly, only 60.3% of participants recognized iodine as the essential nutrient for thyroid health—a gap of public health significance given the well-documented link between iodine deficiency and thyroid disorders such as goiter and hypothyroidism. Moreover, the relatively low proportion (62.0%) acknowledging the necessity of lifelong medication for many thyroid patients reveals an area of vulnerability that could lead to poor treatment adherence, inadequate disease control, and exacerbation of long-term complications. Misunderstandings about disease curability, seen in only 64.8% knowing that thyroid disorders often require chronic management rather than complete cure, further expose a risk of unrealistic expectations and discontinuity in care.

In terms of symptom awareness, while classic signs like fatigue (71.5%), weight changes (hypothyroidism: 75.8%, hyperthyroidism: 72.8%), and rapid heartbeat (74.3%) were reasonably well identified, recognition of the broader mental health impacts (68.0%) and the influence of stress on symptom worsening (65.8%) remained moderate. Furthermore, confusion regarding non-specific or atypical symptoms, reflected in only 64.0% correctly identifying vision improvement as not being a thyroid-related symptom, indicates that some subtle presentations may still be overlooked by the general public, leading to delayed diagnosis.

The cumulative knowledge classification paints a revealing picture: while 73.5% of participants demonstrated either "Very Good" or "Good" knowledge, approximately one-fourth (26.5%) still fell into "Fair" or "Poor" categories. This discrepancy underscores the need for differentiated educational approaches that target not only the general population but also focus specifically on rural communities (where 64.8% of participants resided) and individuals with lower educational attainment, who may have limited access to consistent, reliable health information.

Given that this survey was conducted exclusively via online platforms, it is likely that respondents were relatively more educated, digitally connected, and health-conscious than the general population, implying that the actual knowledge levels in more digitally isolated or marginalized sections of Shimla district could be even lower. Hence, these findings highlight a potentially larger and more pressing public health gap that may not yet be fully visible through online outreach efforts alone.

Addressing these gaps requires a multi-pronged strategy. Public health initiatives must prioritize sustained, culturally sensitive thyroid health education campaigns, especially in rural and semi-urban areas. These efforts should emphasize the critical role of iodine intake (e.g., use of iodized salt), the importance of lifelong adherence to thyroid medication where necessary, early symptom recognition, and the need for routine thyroid function testing even in asymptomatic individuals. Engaging community health workers, leveraging mass media platforms such as radio and regional television, and incorporating thyroid education into school and workplace health programs could significantly enhance reach and impact. Additionally, integrating thyroid disorder screening into existing primary healthcare services and maternal-child health programs would help facilitate early diagnosis, particularly among vulnerable populations such as women of reproductive age and children [8-10].

This study highlights that while residents of Shimla district demonstrate a promising level of basic awareness regarding thyroid disorders, significant knowledge gaps and misconceptions persist that could undermine early diagnosis, effective treatment, and long-term management. Although a considerable proportion of participants exhibited sound understanding of thyroid gland function, common symptoms, the role of screening, and the importance of professional diagnosis, critical deficiencies were noted in areas such as iodine’s role in thyroid health, the chronic nature of thyroid disorders, and the necessity of lifelong medication adherence. The findings underscore the urgent need for targeted, culturally appropriate public health interventions that focus on improving thyroid health literacy, particularly among rural populations and individuals with lower educational attainment. Strengthening community-driven education, integrating thyroid screening into routine primary healthcare services, and leveraging mass media for widespread awareness campaigns will be essential steps toward bridging the knowledge gap, enhancing early detection, promoting better treatment adherence, and ultimately reducing the burden of thyroid disorders in Shimla district.

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