Awareness of Hypothyroidism Complications and Compliance Among Patients With Primary Hypothyroidism in Buraidah, Saudi Arabia.

Background Hypothyroidism is a prevalent endocrine disorder requiring lifelong therapy, yet patient awareness of complications and adherence to levothyroxine remain variable. This study assessed awareness, medication compliance, and their socio‑demographic determinants among patients with primary hypothyroidism attending outpatient clinics at King Fahad Specialist Hospital from January 2025 to December 2025. Methods A cross‑sectional study was conducted among 209 adult patients diagnosed with primary hypothyroidism. Awareness of hypothyroidism complications, compliance, and reasons for nonadherence to medication were assessed using a structured questionnaire. Associations among awareness, compliance, and socio-demographic variables were analyzed using descriptive statistics, the Mann-Whitney Z-test, and Spearman's correlation. Multiple linear regression analysis was performed to determine significant predictors of awareness score. Results The patients were predominantly female (195, 93.3%) and married (169, 80.9%). Awareness of hypothyroidism complications and compliance were both moderate (mean: 6.76±2.21 and 3.04±1.25). Forgetfulness was the most commonly reported reason for non-compliance (187, 89.5%), followed by polypharmacy (80, 38.3%). A strong positive correlation was observed between awareness and compliance (rs=0.585; p<0.001). A significantly higher level of awareness was observed among females (p=0.009), those with higher education (p=0.018), and those diagnosed with hypothyroidism for more than 10 years (p=0.004). Except for marital status, which was associated with higher compliance among married individuals (p=0.025), no significant associations were found between compliance and the rest of the socio‑demographic variables. Multiple linear regression identified gender (β=1.858; 95% CI: 0.681-4.702; p=0.002), higher educational level (β=0.962; 95% CI: 0.267-1.657; p=0.007), and longer duration of hypothyroidism (β=0.925; 95% CI: 0.321-1.529; p=0.003) as independent predictors of higher awareness, after adjusting for age and marital status. Conclusion Patients with hypothyroidism showed moderate awareness of complications and moderate medication compliance. Higher awareness was associated with female sex, higher education, and longer disease duration, although this may be influenced by the predominance of females in the sample. No significant associations were found between compliance and most socio-demographic variables, except higher compliance among married individuals, which may reflect sample distribution rather than an independent effect. A positive correlation was observed between awareness and compliance, suggesting that higher awareness is associated with better adherence. Forgetfulness and polypharmacy were the main barriers to compliance, supporting the need for targeted educational and compliance-support strategies.