International Journal of Preventive Medicine (Int J Prev Med)2008-780212122022011725792579ENDepartment of Community Medicine, Great Eastern Medical School, Ragolu, Srikakulam, Andhra PradeshDepartment of Biochemistry, NRI Institute of Medical Sciences, Vishakhapatnam, Andhra PradeshDepartment of Community Medicine, Great Eastern Medical School, Ragolu, Srikakulam, Andhra Pradesh20220117Background: In India, 42 million people suffer from thyroid diseases. One in 10 adults suffer from hypothyroidism. Although coverage of iodized salt utilization has increased after universal salt iodization, we are yet to achieve the goals of NIDDCP for which the present study was planned to identify the hidden factors. The aim is to identify the factors affecting thyroid hormone levels, their association with salt iodine content and suggest strategies for improvement based on patient perceptions. Methods: A hospital based prospective follow up study was conducted among 140 patients, with an in depth interview and testing of salt iodine content. Data were analyzed using the SPSS software. Results: 96 (69%) patients were of age 18–35 years. 129 (92%) were females, 120 (86%) were from rural areas, 95 (68%) were literate, 116 (83%) were unemployed, and 115 (82%) were of low socioeconomic status. Most of them had poor cooking practices and dietary habits. The T3, T4, and TSH levels were within the normal range in 84 (60%) patients. Only in 28 (20%) salt samples, the iodine content was adequate. The association between factors like intake of inadequately iodized salt (P < 0.01), rural distribution (P < 0.05), illiteracy, presence of the comorbid conditions (P < 0.0001), and thyroid hormone abnormality was found to be statistically significant. Conclusion: The factors that adversely affect thyroid levels were higher age, female gender, rural distribution, comorbid conditions and patients with low salt iodine were prone to abnormal levels. Monitoring salt iodine content, training of health care workers to create awareness were the key strategies proposed for improvement.http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2579http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2579/717718419