Prevalence and Impact of Hypothyroidism Among Students young adult: A Cross-Sectional Study and accuracy of Zulewski’s Clinical Score

Abstract

Background: Hypothyroidism is among the most prevalent endocrine disorders worldwide, characterized by reduced thyroid hormone production, leading to a constellation of physical, cognitive, and emotional symptoms, including fatigue, weight gain, depressive mood, and impaired concentration. Although extensively studied in middle –aged and older adults ,the prevalence, risk factors, and impact of hypothyroidism among young adults, especially university students, remain underexplored. Growing evidence suggests that lifestyle factors common among students—such as stress, poor diet, and irregular sleep—may increase the risk of thyroid dysfunction, warranting focused research in this demographic. Objectives This study is aimed to: determine the prevalence of hypothyroidism among university student saged17–25 years;i) Identify associated risk factors ;ii) assess its impact on academic performance and mental health and iii) evaluatethediagnosticaccuracyofZulewski’sclinicalscoreinthispopulation. Material & Method: A cross-sectional study was conducted among965randomlyselected students at Delta University for Science and Technology. All participants completed a structured questionnaire incorporating Zulewski’s clinical score, questions on family history, lifestyle, and academic performance. Based on clinical suspicion, 281 students were predicted to be at risk. TSH testing using the Atellica SCI Siemens® analyzer was subsequently performed on 158 students who consented to blood sampling. Data were analyzed using IBM SPSS Statistics Version 24.0. Results: The study confirmed overt hypothyroidism (TSH >10 uIU/mL) in 60 students (37.97% of those tested) and subclinical hypothyroidism (TSH 4.2–10 uIU/mL) in 7 students (4.43%). The prevalence was higher among females (36.9%) than males (40.0%), though this difference was not statistically significant (P=0.93). The highest prevalence of overt hypothyroidism was noted in the youngest age group (17–19 years, 43.0%), showing a statistically significant association between age and hypothyroidism (P≈0.043). Students with hypothyroidism frequently reported fatigue, mood disturbances, and decreased academic performance. Lifestyle factors, including high stress, poor diet, and irregular sleep, were common among affected students. Despite the high prevalence, awareness of hypothyroidism symptoms and risk factors was limited, highlighting a significant gap of awareness. The diagnostic evaluation revealed that Zulewski’s clinical score, while useful for initial screening, tended to overestimate prevalence, emphasizing the need for combined clinical and biochemical assessments for accurate diagnosis. Conclusions: Hypothyroidism was found to be relatively common among university students aged 17– 25 years at Delta University, especially among females and younger students. The disease adversely impacted mental health and academic performance. There is a need for targeted awareness campaigns and early screening programs to address this hidden burden. Further multicenter, longitudinal studies are recommended to evaluate long-term outcomes and validate screening tools like Zulewski’s score in young adult populations.