Prevalence and Risk Factors of Subclinical and Overt Hypothyroidism in Saudi Arabia: A Systematic Review.

Hypothyroidism, whether subclinical (SCH) or overt (OH), stands among the most common yet often overlooked endocrine disorders, with its prevalence varying widely across different populations. In Saudi Arabia, factors such as metabolic comorbidities, genetic predisposition, and regional disparities contribute to its epidemiology. This systematic review aimed to summarize the existing literature on the prevalence and risk factors of SCH and OH in Saudi Arabia to lead clinical practice and public health strategies. A comprehensive literature search was conducted to identify relevant studies published in the past decade. Studies meeting predefined inclusion criteria were selected, and data on study characteristics, prevalence, risk factors, and diagnostic methods were extracted. Methodological quality was assessed using a standardized appraisal tool. Due to heterogeneity, a narrative synthesis was performed. Reported prevalence rates varied across populations, with higher rates observed in certain groups such as pregnant women and individuals with specific comorbidities. Female gender, advanced age, family history, and chronic conditions were associated risk factors. Broader screening approaches in pregnancy appeared to identify more SCH cases than selective strategies. Regional differences in prevalence within Saudi Arabia were also noted. Most included studies demonstrated low to moderate risk of bias. The burden of hypothyroidism in Saudi Arabia varies by population and region, with distinct risk factors underscoring the need for tailored screening and management. Expanded screening in high-risk groups and further research on causal pathways are recommended to address this growing health concern.